Plasma exchange in the management of a case of hypertriglyceridaemic pancreatitis triggered by venlafaxine.
The authors present a case of a young, non-diabetic Caucasian male patient with long-standing depression who had recently been started on venlafaxine. He presented to the emergency department with central abdominal pain, drowsiness and vomiting with a raised serum amylase. He was diagnosed with acute pancreatitis (AP) that was confirmed following an abdominal ultrasound and CT. His initial biochemistry was immeasurable in the first 12 h of admission due to macroscopically visible hyperlipidaemia. In the absence of any other causes of AP, hyperlipidaemia was the most likely aetiology. He was transferred to the intensive care unit where he was managed by lipidic restriction, fluid resuscitation and 3 consecutive days of plasma exchange. Plasma triglyceride levels were reduced from 42.9 to 2.4 mmol/l following plasma exchange. He made a full recovery and at discharge was investigated for familial hypertriglyceridaemia and referred to a multi-disciplinary team for follow-up. His venlafaxine was stopped on admission.
Critical Care Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK. sevastrus@gmail.com
Stefan
S
Sevastru
Mai
M
Wakatsuki
Jonathan
J
Fennell
Michael P W
MP
Grocott
D000328:Adult; D003511:Cyclohexanols / Q000009:adverse effects*; D003863:Depression / Q000188:drug therapy; D003937:Diagnosis, Differential; D005440:Fluid Therapy; D006801:Humans; D015228:Hypertriglyceridemia / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000628:therapy*; D010951:Plasma Exchange; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D000069470:Venlafaxine Hydrochloride
D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride