Extreme hypertriglyceridemia managed with insulin

Thuzar, Moe; Shenoy, Vasant; Malabu, Usman H.; Schrale, Ryan G.; Sangla, Kunwarjit S.

doi:10.1016/j.jacl.2014.09.004

Cited by 33 publications

(30 citation statements)

References 17 publications

(11 reference statements)

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“…In acute settings, fasting was shown to increase the effectiveness of drug therapies (20). Decreasing total fat (< 10-15% of total calories) and preferring complex carbohydrates, rich in dietary fiber, is recommended (4).…”

Section: Discussionmentioning

confidence: 99%

“…In cases of severe HTG or HTG-induced pancreatitis, in which an immediate decrease in TG is needed, insulin infusion should be considered -particularly if accompanied by hyperglycemia (20). Insulin activates lipoprotein lipase (LDL) leading to chylomicron degradation, thus increasing TG clearance.…”

Section: Discussionmentioning

confidence: 99%

“…In HTG patients treated with insulin infusion, a mean TG reduction of 40% was reported within the first 24 hours. But in those patients that were fasting and treated with insulin infusion, the TG reduction was 87% (20). Cancer patients receiving chemotherapy usually have poor nutritional status and oral intake.…”

Section: Discussionmentioning

confidence: 99%

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PEG-asparaginase induced severe hypertriglyceridemia

Galindo

Yoon

Devoe

et al. 2016

Arch. Endocrinol. Metab.

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SUMMARYAsparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL, particularly the less toxic pegylated (PEG) formulation. Hypertriglyceridemia (HTG) is a rare complication of PEG-ASP therapy. We report two cases of obese patients who developed severe HTG after receiving PEG for ALL. Both patients were incidentally found to have severe HTG (TG of 4,330 and 4,420 mg/dL). In both patients, there was no personal or family history of dyslipidemia or hypothyroidism. There was no evidence of pancreatitis or skin manifestations of HTG. Both patients were treated with PEG cessation, low-fat diet and pharmacotherapy. Both patients were re-challenged with PEG, with subsequent increase in TG but no associated complications. TG returned to baseline after discontinuing PEG and while on therapy for HTG. A literature review of PEG-induced HTG in adults demonstrated similar results: asymptomatic presentation despite very severe HTG. HTG is a rare but clinically important adverse effect of PEG. Underlying obesity and/or diabetes may represent risk factors. Clinicians should monitor TG levels during PEG therapy to avoid TG-induced pancreatitis. Arch Endocrinol Metab. 2016;60(2):173-7

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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PEG-asparaginase induced severe hypertriglyceridemia

Galindo

Yoon

Devoe

et al. 2016

Arch. Endocrinol. Metab.

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“…Insulin and/or heparin infusions and, more rarely, plasmapheresis have also been recommended . Heparin and/or insulin infusions have been successfully used in cases of HTG‐related pancreatitis, especially when hyperglycaemia was present . Uncontrolled and retrospective case reports and series showed reduced TG levels following plasmapheresis , but minimal outcome data.…”

Section: Introductionmentioning

confidence: 99%

Conservative management in hypertriglyceridemia‐associated pancreatitis

et al. 2019

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Background Severe hypertriglyceridemia (serum triglyceride >10 mmol L−1) is implicated in ~9% of acute pancreatitis cases. Certain guidelines list severe hypertriglyceridemia as an indication for plasmapheresis. Objective We assembled the natural trajectory of triglyceride levels in patients with acute pancreatitis due to severe hypertriglyceridemia who were managed conservatively without plasmapheresis to evaluate the effectiveness of this approach. Methods A retrospective chart review was performed on 22 hospital admissions for acute pancreatitis episodes considered to be caused by severe hypertriglyceridemia. Patients were managed supportively, with cessation of oral intake (NPO) and intravenous hydration. Insulin infusion was used in 12 patients to manage concurrent hyperglycaemia. Results Triglyceride levels for the group were evaluated using a mixed‐effects model. The average triglyceride level fell from 45.4 mmol L−1 on presentation to 13.3 mmol L−1 within 48 h, corresponding to a mean 69.8% decrease. Regression analysis showed a triglyceride half‐life of 30.6 h. Findings were similar for NPO‐only and insulin infusion subgroups. Conclusion Patients with severe hypertriglyceridemia and acute pancreatitis can be conservatively managed safely and effectively without plasmapheresis.

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“…For many patients with DM, poor glucose control will be the primary driver of hypertriglyceridemia and may actually be a presenting symptom at diagnosis of DM [ 59 ]. In these patients, insulin can rapidly lower triglyceride levels in concert with stabilizing blood glucose levels, particularly in patients presenting concurrently with triglyceride-induced pancreatitis and diabetic ketoacidosis (DKA) [ 60 , 61 ]. In one of the largest studies of triglyceride-induced pancreatitis in patients with DKA, at least 11% of patients with DKA had evidence of pancreatitis, with the risk of pancreatitis being associated with the severity of acidosis and hyperglycemia [ 62 ].…”

Section: Treatment Recommendations For Adultsmentioning

confidence: 99%

Hypertriglyceridemia in Diabetes Mellitus: Implications for Pediatric Care

Hartz

Ferranti

Gidding

2018

Journal of the Endocrine Society

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Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). It is estimated that the risk of CVD in diabetes mellitus (DM) is 2 to 10 times higher than in the general population. Much of this increased risk is thought to be related to the development of an atherogenic lipid profile, in which hypertriglyceridemia is an essential component. Recent studies suggest that dyslipidemia may be present in children and adolescents with DM, particularly in T2DM and in association with poor control in T1DM. However, the role of hypertriglyceridemia in the development of future CVD in youth with DM is unclear, as data are scarce. In this review, we will evaluate the pathophysiology of atherogenic hypertriglyceridemia in DM, the evidence regarding an independent role of triglycerides in the development of CVD, and the treatment of hypertriglyceridemia in patients with DM, highlighting the potential relevance to children and the need for more data in children and adolescents to guide clinical practice.

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Extreme hypertriglyceridemia managed with insulin

Cited by 33 publications

References 17 publications

PEG-asparaginase induced severe hypertriglyceridemia

PEG-asparaginase induced severe hypertriglyceridemia

Conservative management in hypertriglyceridemia‐associated pancreatitis

Hypertriglyceridemia in Diabetes Mellitus: Implications for Pediatric Care

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