Plasma Exchange for Hypertriglyceridemic Acute Necrotizing Pancreatitis: Report of Two Cases

Furuya, Tomoki; Komatsu, Masafumi; Takahashi, Ken­ichi; Hashimoto, Naoki; Hashizume, Takumi; Wajima, Naoki; Kubota, Minoru; Itoh, Seiji; Soeno, Takehiko; Suzuki, Kazuyuki; Enzan, K; Matsuo, Shigeki

doi:10.1046/j.1526-0968.2002.00461.x

Cited by 53 publications

(32 citation statements)

References 20 publications

(21 reference statements)

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“…In a study by Piolot et al [35], the regular use of plasmapheresis in patients with severe hypertriglyceridemia and recurring acute pancreatitis prevented further episodes of pancreatitis. Another study stated that plasma exchange should be performed for the treatment of hypertriglyceridemic necrotizing pancreatitis immediately after its onset [36, 37]. …”

Section: Discussionmentioning

confidence: 99%

Management of Acute Severe Hyperlipidemic Pancreatitis

et al. 2006

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Background/Aim: Hypertriglyceridemia is rare and can provoke acute severe hyperlipidemic pancreatitis when triglyceride levels exceed 11.3 mmol/l. In 10 patients we evaluated the therapeutic guidelines for severe hyperlipidemic pancreatitis. Methods: Ten patients (8 men and 2 women) were admitted to the intensive care unit with a diagnosis of acute severe hyperlipidemic pancreatitis. They underwent standard treatment. Heparin, insulin and antihyperlipidemic drugs were used to lower the triglyceride levels. The patients underwent plasmapheresis within 48 h of admission, and fat-free parenteral nutrition was used. Two of the patients underwent surgery because of infection of necrotic segments. Results: Standard treatment was essential for all the patients but plasmapheresis was the procedure that lowered the triglyceride and lipid levels in all cases. It improved abdominal pain, clinical state, and signs and symptoms of the disease. Two patients underwent surgery due to infection of the necrotic segments and one of them died. Follow-up lasted 4–54 months with no recurrences of pancreatitis. Conclusion: Our study shows that standard treatment is essential, but plasmapheresis successfully lowered lipid levels with no complications and relieved the patients from the symptoms in the acute phase of the disease. Hyperlipidemic pancreatitis should initially be treated conservatively. Plasmapheresis is a method that has lately been used successfully for hyperlipidemic pancreatitis. It seems that all therapeutic measures should be applied as early as possible, within the first 48 h.

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Section: Discussionmentioning

confidence: 99%

Management of Acute Severe Hyperlipidemic Pancreatitis

et al. 2006

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“…This rapid removal of lipid particles and triglyceridemia-associated pro-inflammatory agents is the main advantage of plasmapheresis over conservative management and has been effective in clinical practice. It is important to note that the maximal reduction in morbidity and mortality is evident when therapeutic plasmapheresis is used as early as possible [26,27]. This may explain the lack of benefit on the overall mortality and complications that was observed in the retrospective comparison of SHAP before and after the availability of plasmapheresis [28].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasmapheresis in Primary Presentation of Diabetes Mellitus With Diabetic Ketoacidosis, Hypertriglyceridemia and Acute Pancreatitis

Gandham

Yousaf

Win

et al. 2014

World J Nephrol Urol

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Severe hypertriglyceridemia (SHTG)-induced acute pancreatitis has been well described. Currently accepted therapeutic options are limited. We report a case of acute pancreatitis associated with hypertriglyceridemia and diabetic ketoacidosis that was safely and effectively managed with plasmapheresis. A 38-year-old female with history of gestational diabetes presented with acute onset of nausea and abdominal pain. She denied alcohol use and was on oral contraceptive pills. On physical exam, she was afebrile, normotensive, and tachycardic with mild abdominal distension and diffuse tenderness. Diagnostic tests revealed a serum glucose of 414 mg/dL, triglycerides > 816 mg/ dL, amylase of 106 U/L, lipase of 272 U/L, anion gap of 23, BUN of 13 mg/dL, creatinine of 0.3 mg/dL, sodium of 120 mmol/L, HCO 3 of 14 mmol/L, and positive urine ketones. Computed tomography (CT) findings were consistent with severe acute pancreatitis. The patient was managed conservatively on day 1. Due to persistence of symptoms, plasma exchange using NxStage plasmafilter was performed on day 2 and day 3, which resulted in significant reduction of the triglyceride level and resolution of abdominal pain. Patient was discharged home with gemfibrozil and glyburide as maintenance therapy. The exact mechanism of hypertriglyceridemia-induced pancreatitis is not clear. It has been postulated that hyperviscosity of blood due to lipid particles causes ischemia in the pancreas, releasing inflammatory mediators and leading to pancreatic necrosis and inflammation. The advantage of plasmapheresis over conservative management is the removal of lipid particles in a relatively short period of time and clearance of triglyceridemia-associated pro-inflammatory agents.

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“…The literature search continued with articles referenced on UpToDate® on the "Hypertriglyceridemiainduced acute pancreatitis" webpage regarding the treatment of this condition. Many of the articles concerning the various ISSN: 2379-4550 http://digitalcommons.wayne.edu/crp, © 2018 The Author(s) 2 Licensed under Creative Commons Attribution Non-Commercial 4.0 treatment strategies were case reports [1][2][3][4][5][6] or clinical reviews 7 , and no randomized controlled trials were referenced. The patients managed in these case reports had a wide variety of triglyceride levels (1000 mg/dL to >10000 mg/dL) and lipase levels (300 units/L to >7000 units/L) but most patients showed improvement with several different types of therapy and could be discharged from the hospital with no long-term morbidities.…”

Section: Related Literaturementioning

confidence: 99%

High-volume hemofiltration is not preferred for hypertriglyceridemia-induced pancreatitis

Monk

2018

Clin. Res. Pract.

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Plasma Exchange for Hypertriglyceridemic Acute Necrotizing Pancreatitis: Report of Two Cases

Cited by 53 publications

References 20 publications

Management of Acute Severe Hyperlipidemic Pancreatitis

Management of Acute Severe Hyperlipidemic Pancreatitis

Therapeutic Plasmapheresis in Primary Presentation of Diabetes Mellitus With Diabetic Ketoacidosis, Hypertriglyceridemia and Acute Pancreatitis

High-volume hemofiltration is not preferred for hypertriglyceridemia-induced pancreatitis

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