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• W2979827228 abstract "INTRODUCTION: Hypertriglyceridemia is an uncommon cause of acute pancreatitis, comprising 2-7% of cases. The traditional approach to treatment is an insulin drip. In severe cases with signs of organ dysfunction, plasmapheresis/exchange (PLEX) is occasionally trialed, although the data behind this is extremely limited. We present a case of hypertriglyceridemia-induced acute pancreatitis (HTG-AP), resistant to insulin therapy and requiring PLEX for acute management. CASE DESCRIPTION/METHODS: A 36 year old male with diabetes mellitus, hypertension and hyperlipidemia presented to the ED with acute onset mid-epigastric abdominal pain with radiation to the back. On examination, he was tachycardic, appeared visibly uncomfortable and exhibited diffuse tenderness to palpation with voluntary guarding. The patient's lipase was elevated to 220 U/L (>3x the upper limit of normal). A CT abdomen/pelvis revealed pancreatic inflammation and he was diagnosed with acute interstitial pancreatitis. He denied alcohol use. A right upper quadrant ultrasound lacked evidence of gallstones. His records demonstrated poorly controlled hyperlipidemia with triglyceride levels ranging from 362 mg/dL to 1648 mg/dL over 10 years. He reported compliance with his Gemfibrozil and fish oil supplements. On admission, his triglyceride level was 1277 mg/dL. He was placed on an insulin drip for 48 hours without significant change in his clinical picture or triglyceride level, which nadired at 802 mg/dL. The decision was made to initiate PLEX. After his first treatment, his triglyceride level improved to 449 mg/dL and after a second it decreased to 315 mg/dL with corresponding improvement in symptoms. He was discharged on Fenofibrate, Atorvastatin and fish oil supplements. An appointment was scheduled with Endocrinology for further genetic testing and management of his dyslipidemia. DISCUSSION: HTG-APcarries significant morbidity and mortality, up to 40 per 100,000 persons in the Western population, with serious complications typically occurring at triglyceride levels above 1000 mg/dL. Aside from supportive care, an insulin drip is accepted as mainstay therapy. However, our patient did not respond to over 48 hours of standard therapy with profound improvement after PLEX therapy. The evidence for the use of PLEX in this context is solely through observational data. Our patient had a 75% reduction in serum triglycerides with PLEX therapy. We believe that there is a need for randomized trials to elucidate the benefits and risks of PLEX in HTG-AP." @default.
• W2979827228 created "2019-10-18" @default.
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• W2979827228 date "2019-10-01" @default.
• W2979827228 modified "2023-09-23" @default.
• W2979827228 title "1358 A Case of Hypertriglyceridemia Acute Pancreatitis Requiring Plasmapheresis Treatment" @default.
• W2979827228 doi "https://doi.org/10.14309/01.ajg.0000594960.24005.88" @default.
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