Acute pancreatitis owing to very high triglyceride levels treated with insulin and heparin infusion

Abstract

Hypertriglyceridaemia is the third most common cause of acute pancreatitis in the USA. The treatment approach for hypertriglyceridaemia to date has largely been conservative including weight loss, exercise and avoidance of medications that raise triglyceride levels. This approach, however, is not practical in cases of acute pancreatitis due to severely elevated triglycerides. A small number of case reports have been published supporting the treatment of acute pancreatitis due to severely elevated triglyceride levels with insulin and heparin. We report a case of acute pancreatitis in a young woman due to a triglyceride level of 15 215 mg/dl who was successfully treated with insulin and heparin.

Hypertriglyceridemic pancreatitis associated with confounding laboratory abnormalities

“…Treatment of HTGP aims at reducing the TG levels with the use of IV insulin and plasmapheresis ( 8 ). Although a number of falsely low lab values (amylase, TG) were noted in our patient, the overall clinical impression of pancreatitis with history of elevated TG levels, IV insulin was started.…”

Current knowledge of hypertriglyceridemic pancreatitis

“…Most of the evidence for both drugs come from isolated cases [42][43][44][45][46][47][48] or short series of cases [49]. Infusion of unfractionated heparin is able to release lipoprotein lipase (LPL) attached to the endothelial cells, which is followed by a transient reduction in serum TG.…”

Conservative management in hypertriglyceridemia‐associated pancreatitis

“…Heparin and/or insulin infusions have been successfully used in cases of HTG‐related pancreatitis, especially when hyperglycaemia was present . Uncontrolled and retrospective case reports and series showed reduced TG levels following plasmapheresis , but minimal outcome data. A systematic review of apheresis used in HTG‐associated pancreatitis could not determine benefit for morbidity, mortality or pancreatitis severity .…”

“…Insulin and/or heparin infusions and, more rarely, plasmapheresis have also been recommended [6,20]. Heparin and/or insulin infusions have been successfully used in cases of HTGrelated pancreatitis, especially when hyperglycaemia was present [2, 6,[21][22][23][24][25][26][27][28][29][30][31]. Uncontrolled and retrospective case reports and series showed reduced TG levels following plasmapheresis [20,22-24,27,32-,56], but minimal outcome data.…”