Review of High-dose Insulin Infusion for the Treatment of Hypertriglyceridemia-induced Pancreatitis

Abstract

Background: Hypertriglyceridemia-induced pancreatitis (HTGP) is defined as pancreatitis associated with serum triglyceride (TG) levels exceeding 1,000 mg/dL. Current guidelines are lacking in regards to the optimum dose of high-dose insulin infusion (HDII). Aim: We sought to describe our institutional HDII experience for the treatment of HTGP. Method: This was a retrospective, single-center study of patients admitted to the medical intensive care unit between 9/1/2018 and 9/30/2020. Baseline patient characteristics, HDII dose and duration, TG response and use of rescue dextrose or potassium interventions were collected. Patients were excluded if they received therapeutic anticoagulation, plasmapheresis, or an insulin infusion not for HTGP. The primary outcome was the insulin infusion dose and the duration of HDII in relation to the change in serum TG levels. Secondary outcomes included the incidence of hypokalemic and hypoglycemic events. Results: Twelve patients were included in the study. The median admission TG level was 2889.5 mg/dL with a subsequent decrease of 56% at the 24 hour time mark. The median starting dose was 0.09 units/kg/hr which remained stable throughout the treatment period. The median infusion duration was 51.5 hours. Hypokalemia was more common than hypoglycemia, however HDII was not discontinued due to any side effects. Conclusion: Initiating HDII at approximately 0.1 units/kg/hr for HTGP is a safe and effective dose. Half of the patients responded by approximately the 48th hour. Judicious monitoring of serum potassium, glucose and maintenance fluids were required to avoid side effects. Further research comparing different HDII dosages is warranted.