Patient with gemfibrozil-controlled hypertriglyceridemia that developed acute pancreatitis after starting ketogenic diet.
OBJECTIVE
To report the case of a patient with gemfibrozil-controlled hypertriglyceridemia (HTG) that developed acute pancreatitis several days after starting a high-fat ketogenic diet.


METHODS
The patient was evaluated and treated by the authors.


RESULTS
The patient denied viral prodrome or previous symptoms, ethanol consumption, or a known history of cholelithiasis. He was compliant with his gemfibrozil regimen. Clinical examination revealed a tachycardic, febrile, moderately distressed man with exquisite tenderness across the left flank and left abdomen. Laboratory studies revealed increased serum amylase (114 U/L), lipase (530 U/L) and triglyceride (>1000 mg/dL) concentrations. There was a borderline leukocytosis (12800 WBC/mm(3)). Computed tomography of the abdomen demonstrated enlargement and marked inflammatory change to the pancreas. Abdominal ultrasonography revealed no evidence of cholelithiasis or pancreatobiliary obstruction. These findings were diagnostic of HTG-induced acute pancreatitis.


CONCLUSIONS
Ketogenic diets may cause a substantial increase in serum triglycerides and, as a result, may precipitate HTG-induced pancreatitis in those with abnormal lipid metabolism. Patients with a history of HTG should be advised of the potentially deleterious correlation between ketogenic diets and pancreatic function.
Buse
George J
GJ
Department of Surgery, Keesler Medical Center, Keesler Air Force Base, Suite 1A132, 301 Fisher Street, MS 30534, USA. george.buse@cannon.af.mil
Riley
Keyan D
KD
Dress
Christopher M
CM
Neumaster
Terry D
TD
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D000681:Amylases / Q000097:blood; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000009:adverse effects*; D005334:Fever / Q000209:etiology; D015248:Gemfibrozil / Q000627:therapeutic use*; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007659:Ketones / Q000378:metabolism; D008049:Lipase / Q000097:blood; D008297:Male; D009765:Obesity / Q000150:complications / Q000178:diet therapy / Q000378:metabolism; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D015985:Precipitating Factors; D013610:Tachycardia / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000097:blood
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D000960:Hypolipidemic Agents; D007659:Ketones; D014280:Triglycerides; D008049:Lipase; D000681:Amylases; D015248:Gemfibrozil