SHM Converge Scientific Abstract ePoster Gallery-Milky Blood: The Clue to Solving the Case

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This case report describes a 29-year-old man who presented with one day of severe epigastric pain, nausea, and vomiting, with no alcohol use or significant past medical history. He was found to have acute pancreatitis based on abdominal pain, elevated lipase, and CT findings of peripancreatic fluid and inflammatory stranding. Initial labs showed metabolic acidosis with an anion gap, and the CBC was reported as “invalid,” which raised suspicion for marked lipemia.<br /><br />A visual inspection of the blood sample revealed prominent lipemic layering, suggesting severe hypertriglyceridemia as the cause of pancreatitis. His triglyceride level was later confirmed to be 4,425 mg/dL. The patient was treated with standard pancreatitis management, including IV fluids and opioids, along with a continuous insulin infusion started empirically to rapidly lower triglycerides. Dextrose was given concurrently to prevent hypoglycemia, and the insulin/dextrose regimen was titrated to maintain blood glucose between 120 and 180 mg/dL. He was also placed on a low-fat diet and later started on fenofibrate.<br /><br />By discharge, his triglycerides had fallen dramatically to 173 mg/dL, and his clinical course improved. The report emphasizes that hypertriglyceridemia is an important and relatively common cause of acute pancreatitis, with risk increasing substantially at triglyceride levels above 1000 to 2000 mg/dL. It highlights insulin infusion as an effective early treatment option because insulin increases lipoprotein lipase activity and suppresses lipolysis, thereby lowering circulating triglycerides. Plasmapheresis is mentioned as an alternative, but the evidence supporting it remains limited.<br /><br />The authors conclude that hospitalists should recognize hypertriglyceridemia-induced pancreatitis and consider insulin infusion as part of initial management, while discussing plasmapheresis with endocrinology when appropriate.

Asset Subtitle

Ali Farkhondehpour

Meta Tag

Author List Ali Farkhondehpour, Dani Schurr, Liam S. Fitzgerald

Category Clinical Vignettes

Concept Hypertriglyceridemia

Concept Acute Pancreatitis

Concept Triglycerides

Concept Triglyceride Lowering

Concept Insulin Infusion

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Ali Farkhondehpour

Track Adult

Keywords

acute pancreatitis

hypertriglyceridemia

lipemic blood sample

insulin infusion

dextrose therapy

triglyceride level

peripancreatic fluid

fenofibrate

plasmapheresis

lipoprotein lipase

Hypertriglyceridemia

Acute Pancreatitis

Triglycerides

Triglyceride Lowering

Insulin Infusion