scholarly journals Hypertriglyceridemia-induced pancreatitis in pregnancy: case review on the role of therapeutic plasma exchange

2021 ◽  
Vol 2021 ◽  
Author(s):  
Sarah Ying Tse Tan ◽  
Swee Ping Teh ◽  
Manish Kaushik ◽  
Tze Tein Yong ◽  
Shivani Durai ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Case Reports ◽  
Therapeutic Plasma Exchange ◽  
Team Approach ◽  
High Morbidity ◽  
List Type ◽  
Low Fat ◽  
Management Options ◽  
Low Fat Diet ◽  
In Pregnancy

Summary Gestational hypertriglyceridemia-induced pancreatitis is associated with significant maternal and fetal morbidity and mortality. We report a case of gestational hypertriglyceridemia-induced pancreatitis in a primigravida at 31-weeks gestation, complicated by impending preterm labor and metabolic acidosis requiring hemodialysis. This was successfully managed with therapeutic plasma exchange (TPE), followed by i.v. insulin, low-fat diet, and omega-3. Triglyceride levels stabilized after TPE and the patient underwent an uncomplicated term delivery. In pregnancy, elevated estrogen and insulin resistance exacerbate hypertriglyceridemia. Management is challenging as risks and benefits of treatment options need to be weighed against fetal wellbeing. We discuss management options including a review of previous case reports detailing TPE use, dietary optimization, and delivery timing. This case emphasizes the importance of multidisciplinary care to optimize maternal and fetal outcomes. Learning points Gestational hypertriglyceridemia-induced pancreatitis has high morbidity. A multidisciplinary team approach is a key as maternal and fetal needs must be addressed. Rapid lowering of triglycerides is crucial and can be achieved successfully and safely with plasma exchange. A low-fat diet while ensuring adequate nutrition in pregnancy is important. Timing of delivery requires consideration of fetal maturity and risk of recurrent pancreatitis.

scholarly journals Therapeutic plasma exchange for the management of severe gestational hypertriglyceridaemic pancreatitis due to lipoprotein lipase mutation

2020 ◽  
Vol 2020 ◽  
Author(s):  
Albert S Kim ◽  
Rashida Hakeem ◽  
Azaliya Abdullah ◽  
Amanda J Hooper ◽  
Michel C Tchan ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Lipoprotein Lipase ◽  
Therapeutic Plasma Exchange ◽  
Placental Lactogen ◽  
Pharmacological Intervention ◽  
List Type ◽  
Hormonal Changes ◽  
Changes In Pregnancy ◽  
Preconception Counselling ◽  
In Pregnancy

Summary A 19-year-old female presented at 25-weeks gestation with pancreatitis. She was found to have significant hypertriglyceridaemia in context of an unconfirmed history of familial hypertriglyceridaemia. This was initially managed with fasting and insulin infusion and she was commenced on conventional interventions to lower triglycerides, including a fat-restricted diet, heparin, marine oil and gemfibrozil. Despite these measures, the triglyceride levels continued to increase as she progressed through the pregnancy, and it was postulated that she had an underlying lipoprotein lipase defect. Therefore, a multidisciplinary decision was made to commence therapeutic plasma exchange to prevent further episodes of pancreatitis. She underwent a total of 13 sessions of plasma exchange, and labour was induced at 37-weeks gestation in which a healthy female infant was delivered. There was a rapid and significant reduction in triglycerides in the 48 h post-delivery. Subsequent genetic testing of hypertriglyceridaemia genes revealed a missense mutation of the LPL gene. Fenofibrate and rosuvastatin was commenced to manage her hypertriglyceridaemia postpartum and the importance of preconception counselling for future pregnancies was discussed. Hormonal changes in pregnancy lead to an overall increase in plasma lipids to ensure adequate nutrient delivery to the fetus. These physiological changes become problematic, where a genetic abnormality in lipid metabolism exists and severe complications such as pancreatitis can arise. Available therapies for gestational hypertriglyceridaemia rely on augmentation of LPL activity. Where there is an underlying LPL defect, these therapies are ineffective and removal of triglyceride-rich lipoproteins via plasma exchange should be considered. Learning points: Hormonal changes in pregnancy, mediated by progesterone,oestrogen and human placental lactogen, lead to a two- to three-fold increase in serum triglyceride levels. Pharmacological intervention for management of gestational hypertriglyceridaemia rely on the augmentation of lipoprotein lipase (LPL) activity to enhance catabolism of triglyceride-rich lipoproteins. Genetic mutations affecting the LPL gene can lead to severe hypertriglyceridaemia. Therapeutic plasma exchange (TPE) is an effective intervention for the management of severe gestational hypertriglyceridaemia and should be considered in cases where there is an underlying LPL defect. Preconception counselling and discussion regarding contraception is of paramount importance in women with familial hypertriglyceridaemia.

Case Reports of Successful Therapeutic Plasma Exchange in Severe Amitriptyline Poisoning

2007 ◽  
Vol 11 (6) ◽  
pp. 452-454 ◽  
Author(s):  
Benan Bayrakci ◽  
Sule Unal ◽  
Mustafa Erkocoglu ◽  
Handan Yüksel Güngör ◽  
Salih Aksu
Keyword(s):  
Plasma Exchange ◽  
Case Reports ◽  
Therapeutic Plasma Exchange ◽  
Amitriptyline Poisoning

scholarly journals Objective versus Self-Reported Energy Intake Changes During Low-Carbohydrate and Low-Fat Diets

2018 ◽  
Author(s):  
Juen Guo ◽  
Jennifer L. Robinson ◽  
Christopher Gardner ◽  
Kevin D. Hall
Keyword(s):  
Energy Intake ◽  
Calorie Restriction ◽  
List Type ◽  
Low Fat ◽  
Dietary Recall ◽  
Low Carbohydrate Diet ◽  
Model Based ◽  
Low Fat Diet ◽  
Low Carbohydrate ◽  
Fat Diets

AbstractObjectiveTo examine objective versus self-reported energy intake changes (ΔEI) during a 12-month diet intervention.MethodsWe calculated ΔEI in subjects who participated in a 1-year randomized low-carbohydrate versus low-fat diet trial using repeated body weight measurements as inputs to an objective mathematical model (ΔEIModel) and compared these values with self-reported energy intake changes assessed by repeated 24-hr recalls (ΔEI24hrRecall).ResultsΔEI24hrRecall indicated a relatively persistent state of calorie restriction ≥500 kcal/d throughout the year with no significant differences between diets. ΔEIModel demonstrated large early decreases in calorie intake >800 kcal/d followed by an exponential return to approximately 100 kcal/d below baseline at the end of the year. The low-carbohydrate diet resulted in ΔEIModel that was 162±53 kcal/d lower than the low-fat diet over the first 3 months (p=0.002), but no significant diet differences were found at later times. Weight loss at 12 months was significantly related to ΔEIModel at all time intervals for both diets (p<0.0001).ConclusionsSelf-reported measurements of ΔEI were inaccurate. Model-based calculations of ΔEI found that instructions to follow the low-carbohydrate diet resulted in greater calorie restriction than the low-fat diet in the early phases of the intervention, but these diet differences were not sustained.What is already known about this subject?Diet assessments that rely on self-report, such as 24hr dietary recall, are known to underestimate actual energy intake as measured by doubly labeled water. However, it is possible that repeated self-reported measurements could accurately detect changes in energy intake over time if the absolute bias of self-reported of measurements is approximately constant for each subject.What this study addsWe compared energy intake changes measured using repeated 24hr dietary recall measurements collected over the course of the 1-year Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial versus energy intake changes calculated using repeated body weight measurements as inputs to a validated mathematical model.Whereas self-reported measurements indicated a relatively persistent state of calorie restriction, objective model-based measurements demonstrated a large early calorie restriction followed by an exponential rise in energy intake towards the pre-intervention baseline.Model-based calculations, but not self-reported measurements, found that low-carbohydrate diets led to significantly greater early decreases in energy intake compared to low-fat diets, but long-term energy intake changes were not significantly different.

scholarly journals A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE)

2019 ◽  
Vol Volume 10 ◽  
pp. 251-253
Author(s):  
Fatemeh Tara ◽  
Asieh Maleki ◽  
Nayereh Taheri ◽  
Somayeh Moein Darbari
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
In Pregnancy

Therapeutic plasma exchange for Graves’ disease in pregnancy

2021 ◽  
pp. 1753495X2110313
Author(s):  
Matthew Lumchee ◽  
Mimi Yue ◽  
Josephine Laurie ◽  
Adam Morton
Keyword(s):  
Plasma Exchange ◽  
Thyroid Function ◽  
Therapeutic Plasma Exchange ◽  
Graves Disease ◽  
Close Monitoring ◽  
Optimal Management ◽  
Rapid Control ◽  
Preconception Counselling ◽  
Definitive Management ◽  
In Pregnancy

Graves’ disease in pregnancy may be associated with maternal, fetal and neonatal complications, which are proportionate to the severity of hyperthyroidism. Optimal management is detailed preconception counselling, achievement of an euthyroid state prior to conception, and close monitoring of thyroid function and thyroid-stimulating antibodies together with judicious use of anti-thyroid medications during pregnancy. A case of Graves’ disease in pregnancy, complicated by pancytopenia, with a deterioration in thyroid function following cessation of thionamide therapy is described here. Therapeutic plasma exchange was subsequently used to achieve rapid control prior to thyroidectomy. Therapeutic plasma exchange is an effective treatment for hyperthyroidism where thionamides are ineffective or contraindicated, as a bridge to definitive management.

scholarly journals Haemorrhagic cholecystitis: a rare entity not to be forgotten

2018 ◽  
pp. bcr-2018-226469 ◽  
Author(s):  
Zi Qin Ng ◽  
Sharin Pradhan ◽  
Kim Cheah ◽  
Ruwan Wijesuriya
Keyword(s):  
Acute Cholecystitis ◽  
Case Reports ◽  
Rare Condition ◽  
Morbidly Obese ◽  
High Morbidity ◽  
Rare Entity ◽  
Management Options ◽  
Quadrant Pain ◽  
Morbidly Obese Patient ◽  
Clinical Presentations

Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.

scholarly journals Management of glaucoma in pregnancy – balancing safety with efficacy

2021 ◽  
Vol 13 ◽  
pp. 251584142110228
Author(s):  
Rashmi Kumari ◽  
Bhawesh Chandra Saha ◽  
Abhishek Onkar ◽  
Anita Ambasta ◽  
Akanchha Kumari
Keyword(s):  
Minimally Invasive ◽  
Randomized Clinical Trials ◽  
Glaucoma Surgery ◽  
Team Approach ◽  
Medical Laser ◽  
Management Options ◽  
Minimally Invasive Glaucoma Surgery ◽  
Relative Safety ◽  
Pregnancy And Lactation ◽  
In Pregnancy

Glaucoma and pregnancy is an uncommon combination, but it constitutes a very challenging situation for the treating doctor. The challenge is not only controlling the intraocular pressure and preventing glaucoma progression in the mother, but also having to deal with her mental stress and anxiety regarding the safety of her child. The situation is further worsened by the lack of definite guidelines as to how to deal with such patients. Relative rarity of glaucoma in this population restricts any large prospective randomized clinical trials or any large systematic studies. Moreover, none of the existing anti-glaucoma medications is absolutely safe in pregnancy. Current practice patterns depend on some case reports, a few observational studies and a few animal studies that attempt at determining the safety and efficacy of the available medicines. These are then prescribed on the basis of their relative safety in any particular stage of pregnancy or lactation. Newer medications that were released recently in 2018, such as Vyzulta and Rhopressa, presently have limited data to support their safety for use during pregnancy. Laser trabeculoplasty, conventional filtration surgery (of course without anti-metabolites), and minimally invasive glaucoma surgery represent a few non-pharmacological management options. Surgical procedures such as trabeculectomy and tube-shunts or collagen matrix implants, and newer minimally invasive glaucoma surgery procedures such as the gelatin stents are currently being explored and may prove to be viable solutions for severe glaucoma during pregnancy, although they too have their own inherent drawbacks. Management of glaucoma during pregnancy and lactation requires careful consideration of the disease status, gestational stage, US Food and Drug Administration classification and guidelines, and potential benefits and limitations of the various therapeutic modalities. This review focuses on the importance of a multidisciplinary team approach, starting with preconception planning and counseling, determining the treatment options depending on the stage of glaucoma and of pregnancy, and emphasizes the involvement of the patients, their obstetrician, and pediatrician through active discussion regarding the various medical, laser, or surgical modalities currently available or under exploration for use during pregnancy and lactation. The ultimate aim is to achieve an optimal balance between the risks and benefits of any type of intervention, and to customize treatment on an individual basis in order to achieve the best outcomes for both mother and fetus.

scholarly journals Therapeutic plasma exchange in treating multi-organ injury at the later stage of mushroom poisoning: Three case reports

2017 ◽  
Vol 1 (1) ◽  
pp. 61-64
Author(s):  
Li Chen ◽  
◽  
Benxiu Teng ◽  
Juan Luo ◽  
Xianlong Ling ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Case Reports ◽  
Therapeutic Plasma Exchange ◽  
Organ Injury ◽  
Mushroom Poisoning

scholarly journals Adnexal Masses in Pregnancy: Diagnosis and Management

2007 ◽  
Vol 1 (4) ◽  
pp. 66-74 ◽  
Author(s):  
George M Graham
Keyword(s):  
Surgical Intervention ◽  
Adnexal Mass ◽  
Ultrasound Images ◽  
List Type ◽  
Management Options ◽  
Safe Alternative ◽  
Adnexal Masses ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
In Pregnancy

Abstract The widespread use of ultrasound in obstetrics has led to an increase in the diagnosis of asymptomatic adnexal masses in pregnancy. Ultrasound is an accurate and safe method for diagnosing the etiology of an adnexal mass and distinguishing benign from malignant pathology. The management of an adnexal mass in pregnancy is controversial. Historically, it was recommended that any adnexal mass be removed electively in the second trimester to exclude malignancy and prevent complications such as torsion, rupture, and obstruction of labor. More recent recommendations have limited surgical intervention in pregnancy to symptomatic adnexal masses and those that are highly suggestive of malignancy. Surgery in pregnancy is associated with an increased risk of adverse pregnancy outcomes. However, laparoscopy appears to be a safe alternative to laparotomy for benign masses when performed by experienced surgeons. Learning objectives To list the differential diagnoses of adnexal masses in pregnancy To interpret ultrasound images of adnexal masses and distinguish benign from malignant masses To describe the management options for adnexal masses in pregnancy, including the indications and options for surgical intervention.

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