Hyperlipidemia and pregnancy associated pancreatitis with reference to plasma exchange as a therapeutic intervention.

Abstract

A 23 year old pregnant woman presented in her third trimester with severe pancreatitis and hyperlipidemia. Initial investigations suggested that her pancreatitis was induced by profound hypertriglyceridemia, which was the result of an underlying Fredrickson's V type hyperlipoproteinemia exacerbated by pregnancy. Concern for the life of the fetus prompted a caesarean operation and then drainage procedure for pancreatitis. Plasma exchange, carried out to lower the levels of lipids and the pancreatic enzymes, improved the signs and symptoms of the patient. Plasma exchange may be of great use in the management of hyperlipidemic pancreatitis.pancreatitis ; hyperlipidemia ; pregnancy ; plasma exchange CASE REPORTA 23-year-old pregnant woman was admitted to the Department of Obstetrics, Tohoku University Hospital with a history of anterior chest discomfort and epigastralgia. She denied a history of alcohol consumption, pancreatitis, or other kinds of diseases. No diagnosis of hyperlipidemia had been made previously.On admission the patient's temperature was 36.TC, pulse rate 120, and blood pressure 106/76 mmHg. Her weight was 58 kg, and height 153 cm. The patient's conjunctiva was not anemic nor icteric. No cutaneous eruptions, or xanthoma,

Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis

“…HTG is the cause for gestational pancreatitis in 56% cases [23] . Elevated estrogen increases the synthesis of TG and depresses plasma postheparin lipolytic activities by inhibiting the removal efficiency of TG, and high-fat intake may be a cause for AP during pregnancy [24][25][26][27] , which are largely consistent with the results of our study, showing that the patients with HTG were younger with more diet-associated etiologies including overeating, high-fat diet and alcohol abuse. SAP patients with HTG had a higher incidence of hypoalbuminaemia and hypocalcemia and a higher level of admission serum glucose, which may be associated with the aggravation of HTG, resulting from severe stress response and metabolic disorders [28] .…”

Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis

“…This method has been employed with success in patients with acute pancreatitis (7)(8)(9) and in pregnant women with hypertriglyceridemia-induced pancreatitis (10)(11)(12).…”

Management of patients with severe hypertriglyceridaemia during pregnancy: report of two cases with familial lipoprotein lipase deficiency

“…Medium chain triglycerides which channel directly into the portal circulation and are not hydrolysed by lipoprotein lipase should be considered for cooking purposes, but palatability and cost may limit their use. There is no place for the use of anti‐lipaemic medication and, with due attention to the recommendations given in the present report, invasive treatments, such as parentera1 nutrition and plasma exchange, will not be required (Weinberg et al 1982; Sanderson et al 1991; Yamauchi et al 1986).…”