Hypertriglyceridemia-Induced Pancreatitis

A 31-year-old woman was admitted with abdominal pain. Her blood sample was noted to be lipemic. She was not known to have diabetes, hypothyroidism or family history of hyperlipidaemia and denied alcohol intake. She had no eruptive xanthoma or corneal arcus. On admission, triglycerides were 118mmol/L (normal range < 1.8). Computed tomographic scan demonstrated swollen pancreas, extensive peripancreatic inflammation and fatty liver. A diagnosis of hypertriglyceridemia-induced pancreatitis was made. She was kept nil by mouth and commenced on insulin infusion, fenofibrate and a low-fat diet. Her admission was complicated by acute respiratory distress syndrome and difficult pain control requiring morphine patient-controlled analgesia. Her triglycerides gradually reduced and on day 12 it was 6.6mmol/L. This case illustrates the importance of multidisciplinary input with endocrinologist, intensivist, gastroenterologist and dietician. Other treatments that could have been initiated was plasma apheresis but as she improved this was not required.