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A cute pancreatitis refers to inflammation of the pancreas that occurs suddenly and is characterized by severe abdominal pain. 1 Approximately 1-4% of episodes of acute pancreatitis occur when serum triglyceride concentrations exceed 1000-2000 mg/dL. 2-8 About 75% of patients with pancreatitis have a coexisting diagnosis of chronic alcoholism or uncontrolled diabetes. 3 When compared with acute pancreatitis from other etiologies, hypertriglyceridemia-induced acute pancreatitis appears to have a higher degree of severity and more complications. 2 Multiple treatment modalities have been suggested for patients with hypertriglyceridemia-induced acute pancreatitis. Permanent removal of triglycerides by plasmapheresis has been studied as a potential treatment, but the results have been conflicting. 2 Two other treatment strategies with limited supporting data incorporate the use of insulin and heparin to enhance lipoprotein lipase activity. Despite a few case reports in the medical literature, data are lacking in the pharmacy literature regarding this topic. We present a case of hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin.Purpose. A case of hypertriglyceridemiainduced acute pancreatitis that was managed with insulin and heparin is reported. Summary. A 39-year-old Hispanic man arrived at the emergency department with complaints of abdominal pain, nausea, and vomiting over one day. A computed tomography scan of the abdomen revealed peripancreatic inflammatory changes surrounding the tail of the pancreas, consistent with pancreatitis. Pertinent laboratory test values on admission were as follows: triglyceride concentration, 5366 mg/dL; total cholesterol concentration, 555 mg/dL; amylase concentration, 131 units/L; lipase concentration, 51 units/L; serum glucose concentration, 253 mg/ dL; and serum sodium concentration, 128 mmol/L. The patient was diagnosed with hypertriglyceridemia-induced pancreatitis. On hospital day 1, the patient was given nothing by mouth and received a 1-L bolus dose of 0.9% sodium chloride injection, followed by a continuous infusion of 0.9% sodium chloride injection at a rate of 125 mL/ hr. Subcutaneous heparin 5000 units every eight hours, sliding-scale regular insulin, and gemfibrozil 600 mg twice daily were initiated. On hospital day 2, the patient's triglyceride concentration decreased to 2962 mg/dL, and his blood glucose concentration was 147 mg/dL. Subcutaneous insulin detemir 25 units daily was ordered, and sliding-scale insulin was continued. Due to continued elevated triglyceride levels, the patient was transitioned from subcutaneous insulin to an i.v. insulin infusion at 0.1 unit/kg/hr in addition to an infusion of 5% dextrose. On hospital day 5, the patient's triglyceride concentration decreased to 717 mg/dL; the insulin-dextrose infusion was discontinued. The patient was discharged on hospital day 6. Conclusion. A 39-year-old man with pancreatitis caused by severe hypertriglyceridemia was treated with a continuous insulin infusion and subcutaneous h...