[heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases].
BACKGROUND
Hypertriglyceridemia over 1,000 mg/dl can provoke acute pancreatitis and its persistence can worsen the clinical outcome. On the contrary, a rapid decrease in triglyceride level is beneficial. Plasmapheresis has been performed in some patients to remove chylomicrons from the circulation, while heparin and/or insulin have been administered in some other cases to rapidly reduce blood triglycerides. Heparin and insulin stimulate lipoprotein-lipase activity and accelerate chylomicron degradation.


OBJECTIVE
To report five patients with acute pancreatitis treated with heparin and insulin.


METHODS
Five patients (4 females and 1 male) seen in the last two years, who suffered acute pancreatitis induced by hypertriglyceridemia are reported. Initial blood triglyceride levels were above 1,000 mg/dl (range 1,590-8,690 mg/dl). Besides the usual treatment of acute pancreatitis, heparin and/or insulin were administered intravenously in continuous infusion. Heparin dose was guided by usual parameters of blood coagulation, and insulin dose, by serial determinations of blood glucose. Pancreatic necrosis was demonstrated in 4 patients.


RESULTS
Serum triglyceride levels decreased to < 500 mg/dl within 3 days in all cases. No complication of treatment was observed and all patients survived. Early and late complications of pancreatitis occurred in one patient.


CONCLUSIONS
Administration of heparin and/or insulin is an efficient alternative to reduce triglyceride levels in patients with acute pancreatitis and hypertriglyceridemia.
Berger
Z
Z
Sección de Gastroenterología, Unidad de Paciente Crítico, Hospital Clínico, Universidad de Chile, Santos Dumont 999. zberger@terra.cl
Quera
R
R
Poniachik
J
J
Oksenberg
D
D
Guerrero
J
J
D000208:Acute Disease; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002914:Chylomicrons / Q000187:drug effects; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008071:Lipoprotein Lipase / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy* / Q000209:etiology; D014280:Triglycerides / Q000097:blood
D000925:Anticoagulants; D002914:Chylomicrons; D007004:Hypoglycemic Agents; D007328:Insulin; D014280:Triglycerides; D006493:Heparin; D008071:Lipoprotein Lipase