Hypertriglyceridemia-associated acute pancreatitis: Response to continuous insulin infusion

Objective To assess the response of serum triglycerides (TG) to continuous insulin infusion (CII) in adults with hypertriglyceridemia-associated acute pancreatitis (HTGP). Methods Retrospective analysis of TG response to standardized CII therapy in 77 adults admitted to intensive care with TG >1000 mg/dL and HTGP. Results Participants had initial TG 3869.0 [2713.5, 5443.5] mg/dL and were 39.3 ± 9.7 years old, 66.2% males, 58.4% Hispanic, BMI 30.2 [27.0, 34.8] kg/m2, 74.0% with diabetes mellitus (DM) and 50.6% with excess alcohol use. TG-goal, defined as ≤1,000 ± 100 mg/dL, was achieved in 95%. Among the 73 TG-goal achievers (responders), 53.4% reached TG-goal in <36 hours after CII initiation (rapid responders). When compared to slow responders taking≥36 hours, rapid responders had lower initial TG (2862.0 [1965.0, 4519.0] vs 4814.5 [3368.8, 6900.0] mg/dL), BMI (29.4 [25.9, 32.8] vs 31.9 [28.2, 38.3] kg/m2), DM prevalence (56.4 vs 94.1%), and reached TG-50% (half of respective initial TG) faster (12.0 [6.0, 17.0] vs 18.5 [13.0, 32.8] hours). Those with DM (n = 57) vs non-DM (n = 20) were obese (31.4 [28.0, 35.6] vs 27.8 [23.6, 30.3] kg/m2), took longer to reach TG-final (41.0 [25.0, 60.5] vs 14.5 [12.5, 25.5] hours) and used more daily insulin (1.7 [1.3, 2.1] vs 1.1 [0.5, 1.9] U/kg/day). Among those with DM, the rapid responders had higher daily use of insulin vs slow responders 1.9 [1.4, 2.3] vs 1.6 [1.1, 1.8] U/kg/day. All results significant. In multivariable analysis, predictors of faster TG response were absence of DM, lower BMI and initial TG. Conclusion CII was effective in reaching TG-goal in 95% of patients with HTGP. Half achieved TG-goal within 36 hours. Presence of DM, higher BMI and initial TG slowed the time to reach TG-goal. These baseline parameters and rate of decline to TG-50% may be real-time indicators to initiate and adjust the CII for quicker response.

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Exercise in Insulin-dependent Diabetes Mellitus: The Effect of Continuous Insulin Infusion Using the Subcutaneous, Intravenous, and Intraperitoneal Sites

Diabetes Care ◽

10.2337/diacare.6.2.122 ◽

1983 ◽

Vol 6 (2) ◽

pp. 122-128 ◽

Cited By ~ 5

Author(s):

B. R. Gooch ◽

N. N. Abumrad ◽

R. P. Robinson ◽

M. Petrik ◽

D. Campbell ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Infusion ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Insulin Dependent ◽

Continuous Insulin Infusion

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A comparison study of continuous insulin infusion protocols in the medical intensive care unit: Computer-guided vs. standard column-based algorithms

Journal of Hospital Medicine ◽

10.1002/jhm.816 ◽

2010 ◽

Vol 5 (8) ◽

pp. 432-437 ◽

Cited By ~ 47

Author(s):

Christopher A. Newton ◽

Dawn Smiley ◽

Bruce W. Bode ◽

Abbas E. Kitabchi ◽

Paul C. Davidson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Insulin Infusion ◽

Medical Intensive Care Unit ◽

Comparison Study ◽

Medical Intensive Care ◽

Continuous Insulin Infusion

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Hypertriglyceridemia-induced acute pancreatitis with diabetic ketoacidosis: A rare presentation of type 1 diabetes mellitus

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_53_17 ◽

2017 ◽

Vol 9 (04) ◽

pp. 329-331 ◽

Cited By ~ 2

Author(s):

Prabhat Kumar ◽

Abhishek Sakwariya ◽

Amit Ranjan Sultania ◽

Renu Dabas

Keyword(s):

Diabetes Mellitus ◽

Acute Pancreatitis ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Insulin Infusion ◽

Rare Presentation ◽

Chronic Hyperglycemia ◽

Severe Hypertriglyceridemia ◽

Peptide Level

AbstractDiabetic ketoacidosis (DKA) is a frequently encountered complication of diabetes mellitus. DKA is an insulin deficit state and results in moderate to severe hypertriglyceridemia (HTG). HTG is the third leading cause of acute pancreatitis (AP) and often goes unnoticed. The triad of DKA, HTG, and AP is rarely seen, and literature on the same is sparse. We report a case of AP which was due to DKA-induced secondary HTG in an adult with previously undiagnosed type 1 diabetes. His HbA1c was significantly raised, and C-peptide level was low, confirming chronic hyperglycemia. He was treated successfully with insulin infusion, intravenous crystalloid, and analgesics.

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

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/8714390 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Vijay Gayam ◽

Amrendra Kumar Mandal ◽

Pavani Garlapati ◽

Mazin Khalid ◽

Arshpal Gill ◽

...

Keyword(s):

Acute Pancreatitis ◽

Insulin Infusion ◽

Term Treatment ◽

Recurrent Acute Pancreatitis ◽

Nasogastric Feeding ◽

Long Term Treatment ◽

History Of ◽

Laboratory Investigations ◽

Continuous Insulin Infusion

Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL.

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Post-partum hypertriglyceridemia induced acute pancreatitis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205262 ◽

2020 ◽

Vol 9 (12) ◽

pp. 5134

Author(s):

Mahima Arya ◽

Sunita Lalwani ◽

Gargee Pore ◽

Aniket Kakade

Keyword(s):

Diabetes Mellitus ◽

Acute Pancreatitis ◽

Gestational Diabetes ◽

Diabetic Ketoacidosis ◽

Private Hospital ◽

Post Partum ◽

Serum Triglycerides ◽

Random Blood Sugar ◽

Management Protocol ◽

Low Incidence

Gestational hypertriglyceridemia is well established but is considered an unusual cause of acute pancreatitis with a relatively low incidence. We hereby report a notable triad of hypertriglyceridemia, diabetic ketoacidosis and acute pancreatitis in a woman with 2 months of post-partum status delivered at a private hospital with known case of gestational diabetes mellitus. Presenting with acute abdomen with a surprise on table. Salmon pink coloured blood withdrawn in the vacutainer, turning lactescent post centrifugation. Her serum triglycerides level were 1750 mg/dl, random blood sugar of 870 mg/dl and total cholesterol of 978 mg/dl. Computerized tomography of abdomen was confirmatory of acute pancreatitis. Patient was treated aggressively with intravenous (IV) fluid resuscitation and IV insulin therapy as per diabetic ketoacidosis (DKA) management protocol. She recovered well and was discharged on day 4.

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Treatment of Severe Hypertriglyceridemia with Continuous Insulin Infusion

Case Reports in Critical Care ◽

10.1155/2011/293917 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

Yesica Rodríguez Santana ◽

Andrea Nimo Román ◽

Iker García Sáez ◽

José Manuel López Alvarez ◽

Eduardo Consuegra Llapur ◽

...

Keyword(s):

Acute Pancreatitis ◽

Insulin Infusion ◽

Incidental Finding ◽

Emergency Situation ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Genetic Abnormality ◽

Severe Hypertriglyceridemia ◽

Uncontrolled Diabetes ◽

Continuous Insulin Infusion

Severe hypertriglyceridemia (SH) represents a therapeutic emergency because of the possibility of developing cardiovascular events and hyperlipemic acute pancreatitis (PA). Most patients with SH suffer primary or genetic abnormality in lipid metabolism in combination with a precipitating factor such as uncontrolled diabetes mellitus, alcoholism, and drug intake. The standard treatment of hypertriglyceridemia (HTG) with omega 3 fatty acids and fibrates, along with dietary changes, has no effect on an emergency situation. There are no clinical guidelines to SH, but therapy with insulin, heparin, a combination of both, plasmapheresis, or octreotide have been tested succesfully. We report the case of a 10-year-old girl with clinical acute pancreatitis and diabetic ketoacidosis debut, along with incidental finding of an SH, who had a good outcome after treatment with insulin intravenous infusion.

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