AM Report 10/05/16 Hypertriglyceridemia induced Pancreatitis

Remember that Hypercalcemia and Hypertriglyceridemia are etiologies for pancreatitis
TG>1000 usually in hypertriglyceridemia induced pancreatitis

Secondary etiologies of hypertriglyceridemia

1)HYPOTHYROIDISM
2)Diabetes with DKA
3)Alcohol
4)Medications (eg: Clomiphene, protease inhibitors, ART, propofol, olanzapine/mirtazapine)
5)Pregnancy

Clinical features (due to elevated TG)

1)Eruptive Xanthomas  (on extensor surfaces)-see picture below
2)Xanthelesmas (inner canthus of eyelid)-see picture below
3)Lipemic retinalis-see picture below
4)Hepatosplenomegaly

Treatment of HTG related pancreatitis 

1)Fibrate: eg: Gemfibrozil 600 BID-to lower TG level
2)NPO==>low fat diet
3)Isotonic fluids for hydration (avoid LR if hypercalcemia)
4)Pain control-usually IV PRN or PCA
4)Levothyroxine replacement (if due to hypothyroidism)
5)Insulin drip (especially if concomitant hyperglycemia or DKA, works by increasing lipoprotein lipase activity
6)Pheresis– controversial but recommended in severe refractory cases but expensive and invasive

Picture below from medscape (http://emedicine.medscape.com/article/1103971-clinical)

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