CMAJ • September 11, 2007; 177 (6). doi:10.1503/cmaj.1070055.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
Georg Röggla, MD ,
Michael Fasan, MD and
Stylianos Kapiotis, MD
We use a different treatment method (heparin and insulin infusions to stimulate lipoprotein lipase activity and therefore reduce serum triglyceride levels2)as the first-line therapy in our hospital, as described in the following case. A 29-year-old man with an uneventful medical history was admitted to hospital because of severe abdominal pain with a clinical diagnosis of acute pancreatitis. The fasting triglyceride level was nearly 8000 mg/dL at admission. In addition to standard therapy for pancreatitis, an insulin infusion was started at 4 IU/h with glucose substitution as necessary. Low-molecular-weight heparin was also administered. Within 5 days the patient was asymptomatic and his triglyceride level had decreased to 450 mg/dL. His lipemic serum had a milky appearance at admission and a nearly normal clear appearance on day 5 (Figure 1). Case series and case reports describing the treatment of pancreatitis with heparin and insulin have been published,3–5 but the efficacy of this treatment method has not yet been well established, presumably because of the lack of controlled trials.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Treating hypertriglyceridemia
Department of Internal Medicine, General Hospital of Neunkirchen, Neunkirchen, Austria
In their review of hypertriglyceridemia, George Yuan and colleagues advocate "hemodynamic stabilization, cessation of all oral intake, placement of a nasogastric tube and control of metabolic disturbances" to treat triglyceride-related acute pancreatitis.1 The authors are skeptical about the use of plasmapheresis because it provides only a transient benefit.
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We use a different treatment method (heparin and insulin infusions to stimulate lipoprotein lipase activity and therefore reduce serum triglyceride levels2)as the first-line therapy in our hospital, as described in the following case. A 29-year-old man with an uneventful medical history was admitted to hospital because of severe abdominal pain with a clinical diagnosis of acute pancreatitis. The fasting triglyceride level was nearly 8000 mg/dL at admission. In addition to standard therapy for pancreatitis, an insulin infusion was started at 4 IU/h with glucose substitution as necessary. Low-molecular-weight heparin was also administered. Within 5 days the patient was asymptomatic and his triglyceride level had decreased to 450 mg/dL. His lipemic serum had a milky appearance at admission and a nearly normal clear appearance on day 5 (Figure 1). Case series and case reports describing the treatment of pancreatitis with heparin and insulin have been published,3–5 but the efficacy of this treatment method has not yet been well established, presumably because of the lack of controlled trials.
Footnotes
Competing interests: None declared.
REFERENCES
- Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007;176:1113-20.
[Abstract/Free Full Text] - Alagozlu H, Cindoruk M, Karakan T, et al. Heparin and insulin in the treatment of hypertriglyceridemia-induced severe acute pancreatitis. Dig Dis Sci 2006;51:931-3.[CrossRef][Medline]
- Kyriakidis AV, Raitsiou B, Sakagianni A, et al. Management of acute severe hyperlipidemic pancreatitis. Digestion 2006;73:259-64.[CrossRef][Medline]
- Tamez-Perez HE, Saenz-Gallegos R, Hernandez-Rodriguez K, et al. Insulin therapy in patients with severe hypertriglyceridemia. Rev Med Inst Mex Seguro Soc 2006;44:235-7.[Medline]
- Henzen C, Rock M, Schnieper C, et al. Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis. Schweiz Med Wochenschr 1999;129:1242-8.[Medline]
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