8727 Treatment of Hypertriglyceridemia Induced Pancreatitis

Abstract Disclosure: S. Kc: None. M. Tan: None. A. Salim, MD: None. A. Goyal, MD: None. R.K. Maan, MD: None. S. Mahat, MD: None. T. Kattel,MD: None. G.D. Wendell, MD: None. Introduction : Hypertriglyceridemia less commonly causes acute pancreatitis compared to gallstones or alcohol consumption, estimated to be almost 10% of all cases of acute pancreatitis. Hypertriglyceridemia induced pancreatitis is most often caused by primary hyperlipidemia, pregnancy, uncontrolled diabetes, or alcohol consumption. Diagnosis of HTGP includes evaluation of risk factors, physical examination findings and lipid panels. Treatment and management includes diet restriction, plasmapheresis, insulin, and fibrates. Case Report : We present a 39 year old male with a past medical history of hyperlipidemia, alcohol use disorder, depression who presented to the emergency room with left sided abdominal pain and flank pain for the past 2 days. He had nausea but no vomiting and had been off of hypertriglyceridemia treatment for over a year. He smoked half a pack of cigarettes for 15 years and drinks 3-4 alcoholic beverages a day. Physical examination was notable for soft, left lower quadrant tenderness. His triglyceride levels on admission were over 10,000 (normal: <150 mg/dL). LFTs were slightly elevated (AST: 77, ALT: 64, ALP: 150, normal ranges: 5-30 IU/L, 4-46 IU/L, 30-120 IU/L, respectively). He was afebrile with no leukocytosis. Abdominal CT scan showed acute edematous interstitial pancreatitis. The patient was admitted to the ICU. He was made NPO, placed on saline infusions, started Insulin drip, Dextrose drip for recurrent hypoglycemia from the insulin drip, and fenofibrate. Hydromorphone and ketorolac used for pain. On hospital day 2, the patient’s triglyceride level was below 800, and insulin and dextrose drips were discontinued. The patient started on a clear diet. He was transferred over to the floors, where his triglycerides continued to downtrend and abdominal pain improved. Patient was discharged back home on hospital day 5 with fenofibrate, atorvastatin, thiamine, and folic acid. Conclusion : This case report serves as a valuable learning experience by showcasing the interplay of risk factors, the importance of diligent treatment, and the effectiveness of prompt and multi-faceted management of triglyceride-induced pancreatitis. This case also highlights the importance of adhering to treatment to prevent recurrence of HTGP. Finally, aggressive lipid lowering therapy like insulin and fenofibrate reduced the patient’s triglyceride levels in a short time frame. Presentation: 6/3/2024