Insulin Monotherapy for Hypertriglyceridemic Pancreatitis in Non-diabetic Patients: A Case Report and Literature Review

Hypertriglyceridemic pancreatitis (HTGP) is a severe disease that is associated with a higher complication rate compared to pancreatitis caused by other etiologies, and its severity increases in conjunction with triglyceride levels. We report a case of a 57-year-old male with a history of well-controlled hypertension and chronic smoking who presented to the emergency department with clinical, biochemical, and radiological findings suggestive of acute pancreatitis. He had no history of alcohol consumption, and abdominal ultrasound showed no evidence of gallstones, which ruled out both alcoholic and biliary pancreatitis. His lipemic blood specimens and highly elevated serum triglyceride level of 1818 mg/dL confirmed hypertriglyceridemia-induced pancreatic damage. He was managed with conventional acute pancreatitis treatment, including intravenous hydration, bowel rest, and pain medications. Additionally, he was started on an insulin infusion at 0.1 units/kg/hour combined with 10% dextrose to maintain euglycemia. Remarkably, his triglyceride levels dropped significantly over four days to below 500 mg/dL. The patient was discharged in stable condition on anti-hyperlipidemic medication to prevent further attacks. This case emphasizes the importance of recognizing hypertriglyceridemia as an etiological factor of pancreatitis. It also demonstrates the safety and effectiveness of intravenous (IV) insulin infusion in rapidly reducing triglyceride levels in non-diabetic patients. We discuss the proposed pathophysiology, risk factors, and different treatment modalities used for the management of hypertriglyceridemia-induced pancreatitis.