SAT-252 Plasmapheresis as Salvage Therapy for Refractory Hypertriglyceridemia-Induced Pancreatitis Unresponsive to Insulin

Abstract Disclosure: M. Ali: None. H. Angammana: None. M. Colorado Escobar: None. A. Khan: None. A.L. Izzi: None. M. Hashim: None. C. Grantham: None. A. Sajan: None. Introduction: Hypertriglyceridemia (HTG) contributes to nearly 10% of acute pancreatitis cases. Its pathophysiology involves pancreatic lipase hydrolyzing triglycerides, releasing free fatty acids that induce inflammation and pancreatic damage. We present a 41-year-old male with HTG and alcohol use disorder (AUD) who developed acute hemorrhagic pancreatitis, requiring plasmapheresis. This case highlights the critical role of plasmapheresis in managing severe HTG-induced acute pancreatitis with systemic complications, particularly in patients unresponsive to insulin therapy. Case Presentation: A 41-year-old male with a history of AUD, type 2 diabetes mellitus, hyperlipidemia, and hypertension presented to the emergency department with acute epigastric pain lasting one day, resembling a prior episode of pancreatitis, and accompanied by bilious vomiting. Laboratory studies showed triglycerides >3000 mg/dL and lipase 1500 U/L, with imaging confirming hemorrhagic pancreatitis. Despite initial treatment with fluid resuscitation and an insulin drip, his condition worsened, necessitating intubation, mechanical ventilation, and pressor support. The patient underwent plasmapheresis twice, resulting in a significant reduction in triglycerides to <500 mg/dL, allowing discontinuation of the insulin drip. Broad-spectrum antibiotics were initiated due to concerns about pancreatic necrosis and secondary infection. Endocrinology recommended a long-term lipid management strategy, including fibrates, omega-3 fatty acids, and atorvastatin. The patient was eventually extubated and discharged home in stable condition. Discussion: Insulin therapy remains the cornerstone treatment for hypertriglyceridemia (HTG)-induced acute pancreatitis (AP). However, plasmapheresis is indicated in severe cases with extremely elevated triglycerides (>2000 mg/dL), systemic complications, or when medical therapy fails. In this case, plasmapheresis effectively reduced TG levels to <500 mg/dL, resulting in significant clinical improvement after the failure of standard medical treatment. While plasmapheresis has proven beneficial in severe cases, its routine use for all patients with HTG-induced AP is not universally recommended. The decision to utilize plasmapheresis should be individualized, based on TG levels, the severity of pancreatitis, and systemic complications. Additionally, resource availability and expertise play a critical role in determining its application. Triglycerides (<150) and lipase (10-140). Presentation: Saturday, July 12, 2025