Treatment of Hypertriglyceridemia with Aggressive Continuous Intravenous Insulin

Hoff, Abigail; Piechowski, Kara

doi:10.18433/jpps32116

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…Hoff et al described their 23 patient case series in which they demonstrated the e cacy of HDII at a dose of 0.1 units/kg/hr for HTGP, which additionally supports our regarding safety and e cacy. 11 Similarly to Hoff et al, the majority of the patients in our study remained on HDII for approximately 50 hours prior to therapy discontinuation. Although at our institution, there was no formal protocol or guideline, the prescribed HDII dose remained consistent throughout the duration of the infusion until the serum TG levels decreased below 1000 mg/dL.…”

Section: Discussionsupporting

confidence: 60%

“…9,10 Case reports and series demonstrated the e cacy of HDII for the treatment of HTGP, with expert consensus recommending a starting dose of HDII between 0.1-0.3 units/kg/hr. 8,11 in this study, we sought to describe our institutional experience with utilizing HDII for the treatment of HTGP to better characterize e cacy and safety of HDII in HTGP.…”

Section: Introductionmentioning

confidence: 99%

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Review of High-dose Insulin Infusion for the Treatment of Hypertriglyceridemia-induced Pancreatitis

Paplaczyk,

Mahmoud

2023

Preprint

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Background: Hypertriglyceridemia-induced pancreatitis (HTGP) is defined as pancreatitis associated with serum triglyceride (TG) levels exceeding 1,000 mg/dL. Current guidelines are lacking in regards to the optimum dose of high-dose insulin infusion (HDII). Aim: We sought to describe our institutional HDII experience for the treatment of HTGP. Method: This was a retrospective, single-center study of patients admitted to the medical intensive care unit between 9/1/2018 and 9/30/2020. Baseline patient characteristics, HDII dose and duration, TG response and use of rescue dextrose or potassium interventions were collected. Patients were excluded if they received therapeutic anticoagulation, plasmapheresis, or an insulin infusion not for HTGP. The primary outcome was the insulin infusion dose and the duration of HDII in relation to the change in serum TG levels. Secondary outcomes included the incidence of hypokalemic and hypoglycemic events. Results: Twelve patients were included in the study. The median admission TG level was 2889.5 mg/dL with a subsequent decrease of 56% at the 24 hour time mark. The median starting dose was 0.09 units/kg/hr which remained stable throughout the treatment period. The median infusion duration was 51.5 hours. Hypokalemia was more common than hypoglycemia, however HDII was not discontinued due to any side effects. Conclusion: Initiating HDII at approximately 0.1 units/kg/hr for HTGP is a safe and effective dose. Half of the patients responded by approximately the 48th hour. Judicious monitoring of serum potassium, glucose and maintenance fluids were required to avoid side effects. Further research comparing different HDII dosages is warranted.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Review of High-dose Insulin Infusion for the Treatment of Hypertriglyceridemia-induced Pancreatitis

Paplaczyk,

Mahmoud

2023

Preprint

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“…Being in such a particular period—pregnancy period—with no safe access to other treatment options, patients in our institution were given insulin drip as the related literature demonstrated. ( Jin et al, 2018 ; Hoff and Piechowski, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Insulin Treatment of Hypertriglyceridemia During Pregnancy

Cheng

et al. 2022

Front. Pharmacol.

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Objective: This study aims to investigate the efficiency of insulin on the reduction of gestational lipid profiles and try to propose a real-world approach to assist clinicians.Methods: A retrospective, single-centered cohort study of 35 cases was conducted from October 2018 to July 2021 in Shanghai General Hospital. SPSS version 25.0 was performed to analyze the whole data. For continuous variables, a paired-sample t test was carried out on each variable to make a comparison between before and after treatment.Results: The average pre-pregnancy TGs and TCs of these patients were about 3.96 ± 1.42 mmol/L and 4.78 ± 1.18 mmol/L, respectively. The maximum of TG before insulin treatment was up to 64.62 and TC 20.43 mmol/L, which decreased to 17.34 and 4.92 mmol/L after intervention of the insulin drip. TG was noticed to fall by 77% and 12.71% of TG, respectively. The difference of TG and TC between pre-treatment and post-treatment were statistically significant (p < 0.01), while this difference has not been found in the other laboratory tests reports. The outcomes of newborns and mothers with management of insulin were proven to be improved.Conclusion: The use of insulin in the management of gestational hypertriglyceridemia is safe and efficient, and insulin may become a mainstream in the near future to mitigate serum TG and TC levels in the pregnancy period besides regulating the blood glucose level.

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“…The authors did not specify how the dextrose-containing fluid was titrated to prevent hypoglycemia, but no hypoglycemic events were reported. In the Hoff and Piechowski 23 case series of 23 patients, 61% of patients achieved a TG level less than 500 mg/dL following administration of a titratable CI-II and dextrose-containing solution. Similar to Yu et al, the authors did not specify how the dextrose-containing fluid was titrated to prevent hypoglycemia but stated there were no hypoglycemic events that prompted discontinuation of the CI-II.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the numerous studies evaluating the use of CI-II in the management of HTG-AP, it remains unknown how to effectively and safely administer CI-II. [13][14][15][16][17][18][19][20][21][22][23][24][25] Consequently, the management is not standardized, and the existing literature does not consistently demonstrate the benefits of using CI-II. Therefore, the purpose of this study was to evaluate the safety and efficacy of a CI-II order set specifically designed for managing HTG.…”

Section: Introductionmentioning

confidence: 99%

Acute Management of Hypertriglyceridemia With a Disease-Specific Intravenous Insulin Infusion Order Set

Ibarra

2023

Ann Pharmacother

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Background: Hypertriglyceridemia-associated acute pancreatitis is a disease lacking a standardized management approach. Objective: The main objective of this study was to evaluate the safety and efficacy of a continuous intravenous insulin infusion order set specifically designed for managing hypertriglyceridemia. Methods: This study compared the safety and efficacy of a standardized (postintervention) approach to managing hypertriglyceridemia to a nonstandardized (preintervention) approach. The primary efficacy outcome was the percentage of patients who achieved a triglyceride level less than 500 mg/dL. Additional outcomes included the time to achieving a triglyceride level less than 500 mg/dL and the percent reduction in triglyceride levels. The primary safety outcome was the number of patients who experienced hypoglycemia (glucose less than 70 mg/dL). Results: Twenty patients were included in both the preintervention and postintervention groups. There was a significantly greater reduction in triglyceride levels observed in the postintervention group. The number of patients who achieved a triglyceride level less than 500 mg/dL in the preintervention and postintervention groups were 10 (50%) and 17 (85%), respectively, P = 0.018. Within the postintervention group, the time to achieving a triglyceride level less than 500 mg/dL in those with and without diabetes was 56.8 hours (38.2-64.0) versus 27.6 hours (19.7-45.0), respectively, P = 0.028. Conclusion and Relevance: Our findings demonstrate that insulin infusions are safe and effective when therapy is standardized and accounts for nursing to patient ratios. Our results provide the medical community with a standardized approach to acutely managing hypertriglyceridemia.

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Treatment of Hypertriglyceridemia with Aggressive Continuous Intravenous Insulin

Cited by 5 publications

References 22 publications

Review of High-dose Insulin Infusion for the Treatment of Hypertriglyceridemia-induced Pancreatitis

Review of High-dose Insulin Infusion for the Treatment of Hypertriglyceridemia-induced Pancreatitis

Insulin Treatment of Hypertriglyceridemia During Pregnancy

Acute Management of Hypertriglyceridemia With a Disease-Specific Intravenous Insulin Infusion Order Set

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