Treatment of Severe Hypertriglyceridemia with Continuous Insulin Infusion

Abstract

Severe hypertriglyceridemia (SH) represents a therapeutic emergency because of the possibility of developing cardiovascular events and hyperlipemic acute pancreatitis (PA). Most patients with SH suffer primary or genetic abnormality in lipid metabolism in combination with a precipitating factor such as uncontrolled diabetes mellitus, alcoholism, and drug intake. The standard treatment of hypertriglyceridemia (HTG) with omega 3 fatty acids and fibrates, along with dietary changes, has no effect on an emergency situation. There are no clinical guidelines to SH, but therapy with insulin, heparin, a combination of both, plasmapheresis, or octreotide have been tested succesfully. We report the case of a 10-year-old girl with clinical acute pancreatitis and diabetic ketoacidosis debut, along with incidental finding of an SH, who had a good outcome after treatment with insulin intravenous infusion.

Plasmapheresis as an Early Treatment for Severe Hypertriglyceridemia, Acute Pancreatitis, and Diabetic Ketoacidosis

“… 6 Additionally, previous pediatric case reports on this clinical triad have noted reductions of triglyceride levels with IV fluids and insulin therapy alone ( Table 2 ). 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 However, a study by Richardson et al 11 noted that in pediatric patients with SHTG, diabetes, and/or DKA who received IV insulin, the average time for the level of triglycerides to decline to <1000 mg/dL was 3 days and to decline to <500 mg/dL was 23.8 days. The first reported case of plasmapheresis in a pediatric patient with DKA, SHTG, and acute pancreatitis was prompted by renal insufficiency, while the second was prompted by altered mental status.…”

Akute Pankreatitis als schwere Komplikation einer Erstmanifestation eines Typ-2-Diabetes

“…Während Gallenwegserkrankungen und Alkoholabusus häufige Ursachen für eine akute Pankreatitis sind, ist eine Hypertriglyzeridämie mit bis zu 7 % eine der selteneren Ursachen [8].…”

Homoeopathic pathogeneses of dioscorea villosa and the role of dysregulated cholesterol metabolism by the action of diosgenin: A review

“…Others are alcohol and gall stones [50,51] . Acute abdominal pain may be related to pancreatic affection due to secondary cause of altered cholesterol metabolism [52,54] . Increased levels of LDL promote cholesterol accumulation and an inflammatory response in the artery wall.…”