CASE SERIES - INSULIN INFUSION THERAPY IS EFFECTIVE IN HYPERTRIGLYCERIDEMIAINDUCED ACUTE PANCREATITIS
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i3.43909Keywords:
Hypertriglyceridemia, Acute pancreatitis, Insulin infusionAbstract
Objective: Hypertriglyceridemia (HTG) is responsible for up to 10% of all acute pancreatitis (AP) cases. The objective of this study is to present the effects of insulin infusion therapy in HTG-induced AP.
Methods: We had 11 patients with AP and high triglycerides between June 2020 and January 2021 admitted to Bharati Vidyapeeth Medical College and Hospital in Pune, Maharashtra, India. Following laboratory and imaging evaluations, all patients were treated with insulin infusions and supportive care. Following the achievement of triglyceride (TG) level <1000 mg/dL, patients were given Fenofibrate 160 mg OD and Saroglitazar 4 mg OD. We observed their recuperation during the treatment duration.
Results: Our study included 11 AP patients ranging from 18 to 50 years of age, five men and six females. This group included diverse patient population obese, non-obese, diabetic, and non-diabetic patients. TG values ranged from 2200 to 8000 mg/dL, with a mean of 5345.4±1203.8 mg/dL. There were nine patients with moderate pancreatitis, two with mild pancreatitis, and none with severe pancreatitis. Insulin infusions in the range of 302–1008U were required for 2–4 days. TG dropped 17–41% on the 2nd day of insulin infusion and 59–75% on the 3rd day. In all patients, TG levels fell below 1000 mg/dL after 4 days of insulin infusion, and then they were treated with oral anti-lipid medications. Hospital stay ranged from 9 to 25 days, with a 100% recovery rate.
Conclusion: Insulin infusion can be used to treat HTG-induced AP with minimal risk of complications.
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References
Leaf DA. Chylomicronemia and the chylomicronemia syndrome: A practical approach to management. Am J Med 2008;121:10-2.
Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014;25:689-94.
Laufs U, Parhofer KG, Ginsberg HN, Hegele RA. Clinical review on triglycerides. Eur Heart J 2020;41:99-109c.
Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252-61.
Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: An update. J Clin Gastroenterol 2014;48:195-203.
Havel RJ. Pathogenesis, differentiation, and management of hypertriglyceridemia. Adv Intern Med 1969;15:117-54.
Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, et al. A modified CT severity index for evaluating acute pancreatitis: Improved correlation with patient outcome. AJR Am J Roentgenol 2004;183:1261-5.
Manrai M, Kochhar R, Thandassery R, Alfadda A, Sinha S. The revised Atlanta classification of acute pancreatitis: A work still in progress? JOP J Pancreas 2015;16:356-64.
Hegele RA, Ginsberg HN, Chapman MJ, Nordestgaard BG, Kuivenhoven JA, Averna M, et al, European Atherosclerosis Society Consensus Panel. The polygenic nature of hypertriglyceridemia: Implications for definition, diagnosis, and management. Lancet Diabetes Endocrinol 2014;2:655-66.
Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A. Hypertriglyceridemic pancreatitis: Presentation and management. Am J Gastroenterol 2009;104:984-91.
Coskun A, Erkan N, Yakan S, Yildirim M, Carti E, Ucar D, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. Prz Gastroenterol 2015;10:18-22.
Li J, Chen TR, Gong HL, Wan MH, Chen GY, Tang WF. Intensive insulin therapy in severe acute pancreatitis: A meta-analysis and systematic review. West Indian Med J 2012;61:574-9.
Berger Z, Quera R, Poniachik J, Oksenberg D, Guerrero J. heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases. Rev Med Chil 2001;129:1373-8.
Näsström B, Olivecrona G, Olivecrona T, Stegmayr BG. Lipoprotein lipase during continuous heparin infusion: Tissue stores become partially depleted. J Lab Clin Med 2001;138:206-13.
Chen JH, Yeh JH, Lai HW, Liao CS. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272-4.
Stefanutti C, Di Giacomo S, Vivenzio A, Labbadia G, Mazza F, D’Alessandri G, et al. Therapeutic plasma exchange in patients with severe hypertriglyceridemia: A multicenter study. Artif Organs 2009;33:1096-102.
Ito MK. Long-chain omega-3 fatty acids, fibrates, and niacin as therapeutic options in the treatment of hypertriglyceridemia: A review of the literature. Atherosclerosis 2015;242:647-56.
Harris WS. n-3 fatty acids and serum lipoproteins: Human studies. Am J Clin Nutr 1997;65:1645S-54.
Wang SH, Chou YC, Shangkuan WC, Wei KY, Pan YH, Lin HC. Relationship between plasma triglyceride level and severity of hypertriglyceridemic pancreatitis. PLoS One 2016;11:e0163984.
Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: Its etiology, effects and treatment. CMAJ 2007;176:1113-20.
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