title: Extreme hypertriglyceridemia managed with insulin.
abstract: Extreme hypertriglyceridemia can lead to acute pancreatitis and rapid lowering of serum triglycerides (TG) is necessary for preventing such life-threatening complications. However, there is no established consensus on the acute management of extreme hypertriglyceridemia. We retrospectively reviewed 10 cases of extreme hypertriglyceridemia with mean serum TG on presentation of 101.5 ± 23.4 mmol/L (8982 ± 2070 mg/dL) managed with insulin. Serum TG decreased by 87 ± 4% in 24 hours in those patients managed with intravenous insulin and fasting and 40 ± 8.4% in those managed with intravenous insulin alone (P = .0003). The clinical course was uncomplicated in all except 1 patient who subsequently developed a pancreatic pseudocyst. Thus, combination of intravenous insulin with fasting appears to be an effective, simple, and safe treatment strategy in immediate management of extreme hypertriglyceridemia.
authors.affiliation: Department of Endocrinology and Diabetes, The Townsville Hospital, Queensland, Australia; University of Queensland, Australia. Electronic address: m.thuzar@uq.edu.au.
authors.forename: Moe
authors.initials: M
authors.lastname: Thuzar
authors.affiliation: Department of Endocrinology and Diabetes, The Townsville Hospital, Queensland, Australia; James Cook University, Queensland, Australia.
authors.forename: Vasant V
authors.initials: VV
authors.lastname: Shenoy
authors.affiliation: Department of Endocrinology and Diabetes, The Townsville Hospital, Queensland, Australia; James Cook University, Queensland, Australia.
authors.forename: Usman H
authors.initials: UH
authors.lastname: Malabu
authors.affiliation: James Cook University, Queensland, Australia; Department of Cardiology, The Townsville Hospital, Queensland, Australia.
authors.forename: Ryan
authors.initials: R
authors.lastname: Schrale
authors.affiliation: Department of Endocrinology and Diabetes, The Townsville Hospital, Queensland, Australia; James Cook University, Queensland, Australia. Electronic address: kunwarjit.sangla@health.qld.gov.au.
authors.forename: Kunwarjit S
authors.initials: KS
authors.lastname: Sangla
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D005215:Fasting / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D015228:Hypertriglyceridemia / Q000150:complications / Q000188:drug therapy*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007328:Insulin; D014280:Triglycerides
keywords: Diabetes; Dyslipidemia; Hypertriglyceridemia; Insulin; Pancreatitis