Hypertriglyceridemic Pancreatitis Treated with Insulin Therapy: A Comparative Review of 34 Cases

Abstract

Although the clinical presentation of hypertriglyceridemic pancreatitis is usually similar to other forms of acute pancreatitis, it is frequently associated with increased clinical severity and rate of complications. Therefore, appropriate and timely management is of paramount importance in these patients. We performed a structured literature search of the medical databases PubMed and Google Scholar, using the terms “hypertriglyceridemia,” “acute pancreatitis,” “insulin,” and “treatment.” In this search, we identified 34 cases of hypertriglyceridemia-related pancreatitis available in the full-text form in English. The data on patients’ characteristics, epidemiology, clinical features, comorbid conditions, and diagnostic modalities were collected and summarized. This review illustrates that the use of insulin therapy with close monitoring of blood glucose levels is safe. It can be considered as an important component of management in patients with hypertriglyceridemia-related pancreatitis, especially in a clinical setting without the availability of plasmapheresis. Randomized clinical trials are warranted to outline a generalized and efficient treatment regimen for hypertriglyceridemic pancreatitis.

Milk-induced hypertriglyceridaemia and acute pancreatitis after discontinuation of treatment for type 2 diabetes and hyperlipidaemia

“…There is a current lack of guidelines regarding the emergency management of hypertriglyceridaemic acute pancreatitis. Intravenous insulin therapy has been shown to be safe and effective in the immediate management; however, there is a lack of randomised controlled trials to create a standardised treatment regimen 5. Though fibrates have an established role in the long-term reduction of triglycerides and secondary prevention of hypertriglyceridaemic pancreatitis, their role in the emergency setting of acute pancreatitis requires further study 6.…”

Current Diagnosis and Management of Primary Chylomicronemia

“…Insulin stimulates LPL activity, thereby reducing plasma TG levels. Administration of insulin or insulin plus glucose may be considered in non-diabetic patients in the case of severe HTG-induced acute pancreatitis 14,[137][138][139] . Detailed protocols for insulin/ glucose administration have been summarized elsewhere 137,139) .…”

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

“…Cocaine use parameters were delineated in the most detailed amount provided in each included paper. Cocaine-related acute pancreatitis was designated by the preceding use of cocaine and subsequent development of acute pancreatitis after exclusion of all probable etiologies of pancreatitis, including alcoholism, biliary causes, hypertriglyceridemia, drug-induced disease, autoimmune, and hereditary type of pancreatitis [20][21][22][23].…”