Hypertriglyceridemia Induced Pancreatitis (Chylomicronemia Syndrome) Treated with Supportive Care

Uysal, Ersin; Acar, Yahya Ayhan; Gökmen, Emel Sağlam; Kutur, Ahmet; Doğan, Hatice

doi:10.1155/2014/767831

Cited by 4 publications

(8 citation statements)

References 22 publications

(22 reference statements)

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“…HTG-AP is diagnosed as any other acute pancreatitis with presence of 2 of 3 factors: characteristic abdominal pain, elevation of pancreatic enzymes over 3 times the upper limit of normal (ULN), and radiologic evidence of acute pancreatitis. Amylase level at presentation could be normal and should be interpreted with caution due to calorimetric interference of lipaemic serum; and repeat amylase levels should be performed with severe dilutions [ 8 , 16 , 17 ]. Serum TGs level should be measured as soon as the symptoms start as serum TG levels can rapidly trend down with fasting.…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of Hypertriglyceridemia Induced Acute Pancreatitis

Garg

Rustagi

2018

BioMed Research International

148

165

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Hypertriglyceridemia is an uncommon but a well-established etiology of acute pancreatitis leading to significant morbidity and mortality. The risk and severity of acute pancreatitis increase with increasing levels of serum triglycerides. It is crucial to identify hypertriglyceridemia as the cause of pancreatitis and initiate appropriate treatment plan. Initial supportive treatment is similar to management of other causes of acute pancreatitis with additional specific therapies tailored to lower serum triglycerides levels. This includes plasmapheresis, insulin, heparin infusion, and hemofiltration. After the acute episode, diet and lifestyle modifications along with hypolipidemic drugs should be initiated to prevent further episodes. Currently, there is paucity of studies directly comparing different modalities. This article provides a comprehensive review of management of hypertriglyceridemia induced acute pancreatitis. We conclude by summarizing our treatment approach to manage hypertriglyceridemia induced acute pancreatitis.

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Section: Clinical Presentationmentioning

confidence: 99%

Management of Hypertriglyceridemia Induced Acute Pancreatitis

Garg

Rustagi

2018

BioMed Research International

148

165

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“…A more commonly used measure is intravenous insulin perfusion, with or without heparin, also proven to be effective in reducing TG in several studies although the results are not as fast as apheresis. 1,2,3,6,11 Our patient was effectively treated with only supportive care. Some authors defend that this approach may be sufficient, 11 and the clinical improvement should be the guide to choose the treatment options.…”

Section: Case Descriptionmentioning

confidence: 92%

“…1,2,3,6,11 Our patient was effectively treated with only supportive care. Some authors defend that this approach may be sufficient, 11 and the clinical improvement should be the guide to choose the treatment options. The more severe cases, with multiorganic dysfunction and instability, as well as the absence of improvements signs should prompt a more aggressive treatment.…”

Section: Case Descriptionmentioning

confidence: 92%

“…2,4,6,10 HTG can be caused by genetics or by secondary factors, such as uncontrolled diabetes, alcohol or medication. 11 Chylomicronemia syndrome is characterized by the presence of chylomicronemia (TG>1000mg/dL), as well as the presence of eruptive xanthomas, lipemia retinalis or abdominal pain, and it is frequently related with recurrent pancreatitis. 7,11,12 The diagnosis of pancreatitis requires at least two of the three criteria: typical abdominal pain, lipase or amylase serum levels raised more than three times the normal upper limit, and detection by CT. 10 However, serum lipase and specially amylase are less reliable when the pancreatitis is caused by HTG as its concentrations can be in normal range or only mildly elevated.…”

Section: Case Descriptionmentioning

confidence: 99%

“…11 Chylomicronemia syndrome is characterized by the presence of chylomicronemia (TG>1000mg/dL), as well as the presence of eruptive xanthomas, lipemia retinalis or abdominal pain, and it is frequently related with recurrent pancreatitis. 7,11,12 The diagnosis of pancreatitis requires at least two of the three criteria: typical abdominal pain, lipase or amylase serum levels raised more than three times the normal upper limit, and detection by CT. 10 However, serum lipase and specially amylase are less reliable when the pancreatitis is caused by HTG as its concentrations can be in normal range or only mildly elevated. 1,2,10 In our case the diagnosis of pancreatitis was first obscured by the mild elevation of serum levels of amylase and lipase, not superior to three times the normal range on the first evaluation; only on reassessment did the lipase attain diagnostic values, with amylase remaining merely slightly raised.…”

Section: Case Descriptionmentioning

confidence: 99%

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Síndrome de quilomicronemia, el vínculo común entre hiponatremia y pancreatitis

Sousa¹,

Santos²,

Cunha³

et al. 2018

Gal. Clin.

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The clinical condition deteriorated with recrudescence and exacerbation of the abdominal pain. Blood analysis showed a pronounced elevation of CRP 418mg/L, amylase 108U/L, lipase 242 U/L, maintaining the hyponatremia, with normal TSH (Table1). It is relevant to refer that the blood sample was lipemic, with the standing plasma containing a cream layer over a turbid layer. Blood cultures were collected and empiric antibiotic therapy with Piperacillin-Tazobactam started. Further study included abdominal computed tomography ( Fig. 2), relating signs of acute pancreatitis as well as small size gallstones. The patient received treatment with intravenous fluids, fasting and pain control, obtaining clinical improvement. Later we acknowledged the lipid profile results: total cholesterol 1282mg/ dl, HDL 40mg/dl, TG 6221mg/dl. Medical therapy with rosuvastatin 40mg and fenofibrate 267mg was started. During the hospital stay the patient evolved with no complications and no organic dysfunction and after three weeks she was discharged, with TG 994mg/dl. With the diagnosis of type V hyperlipoproteinemia in Fredrickson classification (based on the examination of standing plasma and Total cholesterol/TG ratio) 8,9 , she was referred to genetic testing, but no abnormalities were found. After discharge, the patient presented wavering TG in relation with inappropriate compliance, TG varying from 299 to 5825mg/dl. She had another admission with the diagnosis of pancreatitis and after 6 months she was submitted to cholecystectomy. Two months after surgery the patient had another recurrence of pancreatitis, with TG 5444mg/dl. A magnetic resonance was performed and the possibility of residual choledocholithiasis was discarded.

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Chylous aqueous humor caused by hyperlipidemia: A case report and literature review

Zhao,

Zou,

Xiao

2023

Medicine

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Rationale: Generally, there is no lipoprotein in aqueous humor, and chyle usually exists transiently in the body. Therefore, persistent chylous aqueous humor is rare. Patient concerns: We report a case of a 39-year-old man with persistent milky white appearance over the right eye. Diagnoses: The patient had a history of poorly controlled diabetes for the past 2 years and central retinal vein occlusion of the same eye for the past 2 weeks. The patient’s right eye had a uniform milky appearance in the anterior chamber, transparent cornea, and no keratic precipitate in the posterior cornea. Color Doppler ultrasound of the affected eye showed no obvious inflammation in the vitreous cavity. Laboratory tests revealed severe chylemia. The patient was finally diagnosed as chylous aqueous humor. Interventions and outcomes: After conventional hypolipidemia and hypoglycemia treatment and locally glucocorticoid treatment. The milky white changes in the anterior chamber improved considerably and finally disappeared. Lessons: Although the impact of hyperlipidemia on the cardiovascular system and digestive system is well known, its impact on the eyes is often overlooked. We report a rare case of unilateral chylous aqueous humor caused by hyperlipidemia. Through the analysis of this special case, we recommend that ophthalmologists should pay attention to the impact of blood lipid change on eyes.

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Hypertriglyceridemia Induced Pancreatitis (Chylomicronemia Syndrome) Treated with Supportive Care

Cited by 4 publications

References 22 publications

Management of Hypertriglyceridemia Induced Acute Pancreatitis

Management of Hypertriglyceridemia Induced Acute Pancreatitis

Síndrome de quilomicronemia, el vínculo común entre hiponatremia y pancreatitis

Chylous aqueous humor caused by hyperlipidemia: A case report and literature review

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