Hypertriglyceridemic Pancreatitis: Is Insulin Monotherapy A Feasible Therapeutic Option?

Inayat, Faisal; Zafar, Fahad; Riaz, Iqra; Younus, Fariha; Baig, Asad S; Imran, Zahid

doi:10.7759/cureus.3461

Cited by 13 publications

(16 citation statements)

References 16 publications

(25 reference statements)

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“…Abdominal ultrasound ruled out the gallstones and other abnormalities in the gallbladder. Furthermore, her serum triglyceride levels were within normal limits and her urine pregnancy test was negative [ 29 ]. She had normal serum IgG4 levels, no history of prior pancreatitis episodes, and no evidence of IgG4-associated autoimmune systemic disease or concomitant inflammatory bowel disease.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis secondary to cocaine use: a case-based systematic literature review

Goraya

Malik

Inayat

et al. 2021

Clin J Gastroenterol

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Cocaine use continues to be an important global public health problem. As the use of cocaine remains pervasive so have a myriad of adverse events associated with this drug. These deleterious effects are well-studied, but gastrointestinal complications remain esoteric and the existing clinical evidence is scarce. Ischemia of the esophagus and small bowel, perforation, peptic ulceration, gastrointestinal bleeding, and ischemic colitis are among the reported complications. In specific, acute pancreatitis secondary to cocaine use is an exceedingly rare clinicopathologic entity. To date, only 7 cases of this condition have been reported in the English-language literature. We hereby delineate a rare case of a 29-year-old female who developed her first episode of cocaine-associated pancreatitis. The diagnosis was made based on a standard battery of investigations and meticulous exclusion of common etiologies of acute pancreatitis. To our knowledge, this case represents the first report of re-occurrence of acute pancreatitis upon subsequent crack cocaine insufflation, adding a higher level of evidence to a fallible association. We also present a systematic review of the existing literature on acute pancreatitis following cocaine use. An updated knowledge regarding this rare association is of paramount importance for early diagnosis and astute management.

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Section: Discussionmentioning

confidence: 99%

Acute pancreatitis secondary to cocaine use: a case-based systematic literature review

Goraya

Malik

Inayat

et al. 2021

Clin J Gastroenterol

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“…Intravenous insulin infusion therapy has previously been used in these patients with promising outcomes to decrease serum triglyceride. 5 The mechanism by which insulin lowers the level of serum triglycerides is by enhancing lipoprotein lipase activity, an enzyme that accelerates chylomicron and very low-density lipoprotein metabolism to glycerol and FFAs. 14 15 Therefore, it ultimately decreases the serum triglyceride levels.…”

Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis with acute severe hypertriglyceridaemia-induced pancreatitis as first presentation of type 2 diabetes

2021

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Acute pancreatitis (AP) is an acute destructive inflammatory condition of the pancreas. Hypertriglyceridaemia is the third most common worldwide cause of AP. Although the presentation of hypertriglyceridaemic pancreatitis (HTGP) is usually similar to other forms of AP, it may cause more severe AP and worse symptoms. Therefore, apart from the supportive care and treatment for AP, it is necessary to treat the underlying aetiology. There are no established guidelines for managing HTGP. Many treatment modalities have been reported, including intravenous insulin infusion, heparin and plasmapheresis. Randomised trials comparing their efficacy are lacking. Diabetic ketoacidosis (DKA) may be a risk factor for AP, but it is uncertain if AP triggers DKA or vice versa. Here, we describe a case of a 44-year-old man who presented with DKA concurrent with acute severe HTGP as first manifestation of type 2 diabetes mellitus. He was successfully managed with supportive care and intravenous insulin infusion.

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“…Treating the concurrent DKA is also crucial, as decreased insulin causes a rise in the triglyceride level in the blood, creating a hindrance in the management of HTG. The use of insulin in such cases is bifold, as it manages DKA while also improving HTG by activating lipoprotein lipase [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia-Induced Pancreatitis Complicated by Diabetic Ketoacidosis

Naqvi¹,

Haider²,

Patel³

et al. 2021

Cureus

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Acute pancreatitis is a potentially fatal clinical entity having multiple underlying triggers. Though the incidence of hypertriglyceridemia-induced pancreatitis is low; however, patients with such risk factors develop severe disease. We present a case of a 47-year-old male who came to our facility with complaints of epigastric pain. Physical examination and laboratory workup unmasked the presence of pancreatitis alongside concurrent diabetic ketoacidosis (DKA). This presentation is unique, and to our knowledge, only a few cases have been reported in the literature. Furthermore, the co-existence of pancreatitis and DKA can overlap the clinical picture of each other, which might lead to unwanted complications if not diagnosed timely.

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Hypertriglyceridemic Pancreatitis: Is Insulin Monotherapy A Feasible Therapeutic Option?

Cited by 13 publications

References 16 publications

Acute pancreatitis secondary to cocaine use: a case-based systematic literature review

Acute pancreatitis secondary to cocaine use: a case-based systematic literature review

Diabetic ketoacidosis with acute severe hypertriglyceridaemia-induced pancreatitis as first presentation of type 2 diabetes

Hypertriglyceridemia-Induced Pancreatitis Complicated by Diabetic Ketoacidosis

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