12563 Very Severe Hypertriglyceridemia-Induced Pancreatitis

Abstract Disclosure: J. Abrams: None. L. Fan: None. Background: Very severe hypertriglyceridemia (HTG) (triglyceride (TG) > 2000 mg/dl) occurs in 1.8 per 10,000 adults and portends a >50% risk of pancreatitis. We present a rare case of HTG (TG > 10,000) induced pancreatitis. Clinical Case: A 33-year-old man presented with acute onset abdominal pain, nausea, and vomiting for 12 hours. Clinical presentation was similar to a prior admission for acute pancreatitis 4 months ago, where TG level was 705 mg/dL. At that time, he was made NPO, treated with lactated ringers at 150 cc/hour, and discharged on gemfibrozil 600 mg twice daily. The patient was lost to follow up after discharge. On this admission, patient reported non-adherence to gemfibrozil, only resuming medication after abdominal pain began 12 hours prior to admission. Initial tests showed Lipase 198 U/L (reference range: 8-78 U/L), WBC 8.2K/uL (reference range: 4.5-11 K/uL), Cr 0.69 mg/dL (reference range: 0.7-1.3 mg/dL), Total cholesterol 477 mg/dL (reference range <200 mg/dL), HDL 19 mg/dL (reference range: >40 mg/dL), LDL “unable to calculate”(reference range <130 mg/dL), A1c 6.3% (reference range: 4.0-5.6%), TG 11,772 mg/dL (reference range: <150 mg/dL desirable, 150-199 mg/dL borderline, 200-499 mg/dL high risk, >500 mg/dL very high risk), repeat TG 8,151 mg/dL. CT abdomen scan confirmed peripancreatic edema and fat stranding, consistent with acute pancreatitis. Pertinent exam revealed temperature 98.2⁰F, pulse 61 beats/min, respirations 16 breaths/min, blood pressure 166/110 mmHg, oxygen saturation 97%, BMI 29.69 kg/m2; skin negative for xanthomas; abdomen tender to palpation in epigastrium, no guarding or rebound, bowel sounds present. He was made NPO, treated with normal saline, and admitted to intensive care, and started on an insulin drip with a rate of 0.1 unit/kg/hour with D5 1/2NS initially at 100 cc/hr titrated to maintain glucose 150-200. The subsequent TG level drawn 37 hours after admission was 531 mg/dL, 427 mg/dL at 43 hours, 428 mg/dL at 51 hours, 532 mg/dL at 72 hours, and 419 mg/dL at 96 hours. The insulin drip was stopped after 16 hours and low fat (<20%) diet was started. Compliance with low fat diet and fibrate therapy (atorvastatin 40mg daily, fenofibrate 245mg daily) was emphasized to the patient at discharge. Conclusion: This patient is one of the few reported cases of severe (TG>10,000) hypertriglyceridemia induced pancreatitis. Presentation: 6/3/2024