Importance of Diet Modification in Preventing Recurrent Episodes of Hypertriglyceridemic Pancreatitis (HTGP)

Background: Hypertriglyceridemic pancreatitis (HTGP) typically occurs in patients with an underlying dyslipidemia. While the incidence is low (2–4%), HTGP has a higher likelihood of recurrence than other forms of pancreatitis. A multifaceted approach is necessary to prevent recurrences of HTGP. Diet modification is an integral part of management, but is usually not well emphasized in this patient population. Clinical Case: A 22 year old male with hx of recurrent pancreatitis due to familial hypertriglyceridemia presented to the emergency department with epigastric pain beginning on morning of admission. The patient’s 1st pancreatitis episode was 1 year ago and he had 8 incidences of pancreatitis due to elevated triglyceride levels. One episode required ICU stay due to pressor requirement. Patient noted medication compliance to gemfibrozil since this admission, however stated that he had not made any changes in his diet since diagnosis 1 year ago. Patient had been abstinent from alcohol and drugs 6 months prior to admission. Patient’s triglyceride level on admission was 1,203 and was started on insulin drip. However, due to persistent hypoglycemia was also placed on D5 mIVFs. Despite the fluids, patient continued to be hypoglycemic and insulin drip was stopped for a short period of time with the triglyceride level in the 700s. The following night, patient was placed back on insulin drip at higher rate and became hypoglycemic again. Consequently, insulin drip was turned off the following morning. Triglyceride level continued to downtrend to 510. Insulin drip was restarted at a lower rate later that day. A recheck of triglyceride level that day showed that triglyceride decreased to 470. Patient was placed back on gemfibrozil with niacin added to the regimen and discharged home after a detailed discussion about diet changes. Discussion: This case study illustrates a patient with multiple episodes of pancreatitis due to elevated triglyceride levels despite compliance to gemfibrozil, resulting in refractory hypoglycemic episodes during his most recent admission from chronic damage to the pancreas’s alpha cell activity. While medication compliance is important, diet modification is as well. The above case sheds light on the importance of long-term diet modification in patients including restriction of dietary fat, simple carbohydrates and alcohol.