Hypertriglyceridemia-induced acute pancreatitis

www.nursingcriticalcare.com Hypertriglyceridemia (HTG) is a disorder where a patient’s serum triglyceride level is greater than 150 mg/dL (normal, less than 150 mg/dL).1 In the US, about 200,000 hospital admissions annually are due to acute pancreatitis, and this figure has been increasing.2 HTG is an important cause of acute pancreatitis and hypertriglyceridemia-induced pancreatitis (HTGP) occurs in 1% to 14% of patients diagnosed with acute pancreatitis.3,4 The risk of developing pancreatitis significantly increases when triglyceride levels are above 200 mg/dL.5 Both primary (genetic) and secondary disorders of lipoprotein metabolism are associated with HTGP. Primary disorders include type I dyslipidemia, also known as familial chylomicronemia. Secondary disorders include poorly controlled diabetes mellitus (types 1 and 2) and diabetic ketoacidosis.4 Pathophysiology Pancreatitis is an inflammation of the pancreas. In pancreatitis, intra-acinar activation of pancreatic enzymes (including trypsin, phospholipase A2, and elastase) can lead to autodigestion of the pancreas.6 These pancreatic enzymes damage tissue and activate the complement system and inflammatory cascade resulting in cytokine production, edema, inflammation, and sometimes necrosis. Injury occurs to the pancreatic cells with subsequent activation of the trypsinogen inside of the pancreas instead of in the duodenum; trypsinogen is then activated to trypsin by enterokinase. Normally, trypsin inhibitors in the pancreas inactivate the trypsin produced, but this fails to occur in an individual with pancreatitis, as digestive enzymes are secreted improperly leading to inflammation and autodigestion of the pancreas.6 Abstract: Hypertriglyceridemia-induced acute pancreatitis causes significant morbidity and mortality. It is important to promptly identify the underlying etiology and deliver the appropriate care to affected patients. Management includes supportive care and attempts to lower the serum triglyceride level. A case report of a patient treated successfully with an insulin infusion is presented.