SHM Converge Scientific Abstract ePoster Gallery-Beyond Booze and Stones - A Case of Hypertriglyceridemia-Induced Pancreatitis

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This case report describes a 38-year-old woman with recurrent pancreatitis who developed severe hypertriglyceridemia-induced pancreatitis (HTGP). She had no alcohol use and had previously undergone cholecystectomy, making common causes of pancreatitis less likely. On presentation, she had abdominal pain, nausea, vomiting, epigastric tenderness, a lipase level greater than 6,000 U/L, and CT evidence of pancreatic edema. Her triglycerides were extremely elevated at over 3,500 mg/dL, with associated low ionized calcium.<br /><br />She was initially treated with intravenous insulin, then admitted to the ICU for fluids, pain control, and continued insulin therapy. Her hospital course was complicated by acute kidney injury requiring temporary hemodialysis. Because of the severity of her hypertriglyceridemia, she also underwent plasmapheresis, which helped rapidly lower triglyceride levels and resolve the pancreatitis. She was discharged on gemfibrozil for long-term lipid control.<br /><br />The report highlights that HTGP is the third most common cause of acute pancreatitis and becomes much more likely when triglycerides exceed 1,000 mg/dL. The proposed mechanism includes toxic free fatty acids generated from triglyceride breakdown and capillary plugging from chylomicron-rich blood, leading to inflammation, ischemia, and acidosis.<br /><br />Treatment of HTGP includes standard pancreatitis care—bowel rest, IV fluids, and pain management—plus triglyceride-lowering therapy. Insulin can reduce triglycerides by activating lipoprotein lipase, but it carries a hypoglycemia risk. Plasmapheresis may lower triglycerides quickly, but evidence for improved outcomes is limited, and it is costly and resource-intensive. The authors conclude that more research is needed to clarify the benefits of combining insulin and plasmapheresis, especially regarding early use and mortality outcomes.

Asset Subtitle

Rohan Dod

Meta Tag

Author List Rohan Dod, Sami Tahhan, Tarik Alagha

Category Clinical Vignettes

Concept Hypertriglyceridemia-Induced Acute Pancreatitis

Concept Hypertriglyceridemia

Concept Acute Pancreatitis

Concept Triglycerides

Concept Free Fatty Acid

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School

Presenting Author Rohan Dod

Track Adult

Keywords

hypertriglyceridemia-induced pancreatitis

acute pancreatitis

plasmapheresis

intravenous insulin

triglycerides

lipase

acute kidney injury

gemfibrozil

chylomicronemia

ICU care

Hypertriglyceridemia-Induced Acute Pancreatitis

Hypertriglyceridemia

Acute Pancreatitis

Triglycerides

Free Fatty Acid