Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin

Abstract

IntroductionHypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented.AimTo present 12 cases of AP successfully treated by insulin administration.Material and methodsThree hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients’ medical records were retrospectively evaluated in this study.ResultsSerum triglyceride levels decreased to < 500 mg/dl within 2–3 days. No complications of treatment were seen and good clinical outcome was observed.ConclusionsOur results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.

Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review

“…Management is important in HTG AP due to a high risk of complications. Insulin infusion has been used in literature successfully [ 15 , 16 ]. However, selected patients with severe HTG AP might benefit from plasmapheresis, but evidence to support its use needs to be validated from various trials [ 17 , 18 ].…”

Hypertriglyceridemia–induced acute pancreatitis: a systematic review of the literature

“…Six patients had severe acute pancreatitis and eight presented diabetes mellitus. In all cases, following insulin therapy, the triglycerides decrease to less than 500 mg/dL in a mean time of three days [43]. This effect of insulin explains why patients with uncontrolled type one and two diabetes mellitus may develop HAP due to excessive lipolysis from the absence of insulin effect during diabetic ketoacidosis [44].…”

“…Patel recommends an insulin infusion of 0.1 IU/kg/h co-administered with dextrose, to keep the blood glucose between 150-200 mg/dL [40]. Coskun et al added to usual treatment insulin therapy in 12 patients with HAP [43]. Six patients had severe acute pancreatitis and eight presented diabetes mellitus.…”

Management of hypertriglyceridaemic pancreatitis in the acute setting and review of literature

“…CT imaging subsequently confirmed acute necrotising pancreatitis with no evidence of gallstones (also absent on abdominal ultrasound). The patient scored 2points (glucose >11.1 mmol/L; white cell count >16×10 9 /L) on Ranson’s criteria (on admission) and a Balthazar score (CT severity index) indicating severe AP (peripancreatic inflammation, necrosis <30%) 4. This was despite an apparently normal amylase result—discussed further below.…”