title: Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin.
abstract: OBJECTIVE
  A case of hypertriglyceridemia-induced acute pancreatitis that was managed with insulin and heparin is reported.
  
  
  CONCLUSIONS
  A 39-year-old Hispanic man arrived at the emergency department with complaints of abdominal pain, nausea, and vomiting over one day. A computed tomography scan of the abdomen revealed peripancreatic inflammatory changes surrounding the tail of the pancreas, consistent with pancreatitis. Pertinent laboratory test values on admission were as follows: triglyceride concentration, 5366 mg/dL; total cholesterol concentration, 555 mg/dL; amylase concentration, 131 units/L; lipase concentration, 51 units/L; serum glucose concentration, 253 mg/dL; and serum sodium concentration, 128 mmol/L. The patient was diagnosed with hypertriglyceridemia-induced pancreatitis. On hospital day 1, the patient was given nothing by mouth and received a 1-L bolus dose of 0.9% sodium chloride injection, followed by a continuous infusion of 0.9% sodium chloride injection at a rate of 125 mL/hr. Subcutaneous heparin 5000 units every eight hours, sliding-scale regular insulin, and gemfibrozil 600 mg twice daily were initiated. On hospital day 2, the patient's triglyceride concentration decreased to 2962 mg/dL, and his blood glucose concentration was 147 mg/dL. Subcutaneous insulin detemir 25 units daily was ordered, and sliding-scale insulin was continued. Due to continued elevated triglyceride levels, the patient was transitioned from subcutaneous insulin to an i.v. insulin infusion at 0.1 unit/kg/hr in addition to an infusion of 5% dextrose. On hospital day 5, the patient's triglyceride concentration decreased to 717 mg/dL; the insulin-dextrose infusion was discontinued. The patient was discharged on hospital day 6.
  
  
  CONCLUSIONS
  A 39-year-old man with pancreatitis caused by severe hypertriglyceridemia was treated with a continuous insulin infusion and subcutaneous heparin.
authors.affiliation: Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA. jennifertwilla@mlh.org
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Twilla
authors.forename: Jimmie
authors.initials: J
authors.lastname: Mancell
mesh_terms: D000208:Acute Disease; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D015248:Gemfibrozil / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010195:Pancreatitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D000925:Anticoagulants; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D006493:Heparin; D015248:Gemfibrozil