VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

09 Hypertriglyceridemia-Induced End-Organ Damage

Janice Chuang, DO; Ryan O’Connell, DO Corresponding author: Janice.chuang@lpnt.net

Context: Acute pancreatitis is the most common gastrointestinal cause of hospitalization in the United States, with the most common cause as gallstones, followed closely by alcohol use. The cornerstones of management include aggressive IV hydration, pain management, and nutrition. Here, we will explore a case of hypertriglyceridemia-induced acute pancreatitis. Case Report: 22-year-old male with a past medical history of insulin-dependent diabetes mellitus who reported to the ED with abdominal pain. Medical History: Insulin-dependent diabetes mellitus Family History: Diabetes mellitus Social History: Lives with family. Independent of all basic ADLs. Pertinent Review of Systems: Abdominal pain. SOVAH Health Internal Medicine Residency Program Edward Via College of Osteopathic Medicine-Virginia Campus

Pertinent Physical Exam: Obese male. Drowsy. Abdominal painful to palpation along upper quadrants. Pertinent Labs: WBC 13.4. Glucose 368. Lipase 969. Beta-hydroxybutyrate 4.23. Imaging: CT abdominal pelvic with IV contrast Diagnosis: SIRS criteria secondary to DKA and acute pancreatitis. Hypertriglyceridemia-induced acute pancreatitis. Treatment: The patient was started on IV fluid supplementation, anti-emetics, and insulin drip. He was kept NPO and given PRN pain medications. He continued to have persistent severe abdominal pain. Labs showed worsening bandemia with concerns for possible pancreatic necrosis, deteriorating renal function, and severe hypocalcemia. Nephrology was consulted and recommended transfer to a tertiary care facility for plasmapheresis. The patient was transferred to a nearby tertiary care facility.

Comments: Hypertriglyceridemia is an uncommon but well-known cause of acute pancreatitis, with the risk and severity of the disease tied to the level of serum triglycerides. Levels over 1000 have been associated with acute pancreatitis. Based on the prevalence of hypertriglyceridemia in the United States, about 1.7% of the adult population of 3.4 million Americans have levels greater than 500, with over 70% of those being male.

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