Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog

Abstract

Objective: To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog.Case Summary: A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus.New or Unique Information Provided: This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided. K E Y W O R D Sfenofibrate, glargine U300, insulin constant rate infusion, lipemia retinalis, manual therapeutic plasma exchange INTRODUCTIONHypertriglyceridemia is a negative prognostic indicator in hospitalized dogs. 1 In people, severe hypertriglyceridemia (>11.