We discussed a case of a man w/ HLD, IDDM2, Obesity, hx of pancreatitis, who presented to the hospital for acute epigastric pain, decreased PO intake, and non-bloody / non-bilious emesis. He was diagnosed with Hypertriglyceridemia-induced Acute Pancreatitis.
We discussed how to approach abdominal pain as well as pearls when treating hypertriglyceridemia-induced acute pancreatitis.
Framework for abdominal pain
- R/o emergencies: obstruction, perforation, vascular, ectopic pregnancy.
Hypertriglyceridemia-induced acute pancreatitis
- Triglycerides are broken down into free fatty acids that accumulate to toxic levels, which can cause inflammation of the pancreas.
- Early (within ~48 hrs) enteral refeeding is encouraged.
- Enteral (PO) feeding is recommended over parenteral (IV) to help maintain intestinal barrier and prevent bacterial translocation from the gut.
Insulin is used to treat hypertriglyceridemia-induced acute pancreatitis. Insulin promotes storage of triglycerides and inhibits breakdown of triglycerides into free fatty acids.