Elsevier

Journal of Clinical Lipidology

Volume 8, Issue 6, November–December 2014, Pages 630-634
Journal of Clinical Lipidology

Case Studie
Extreme hypertriglyceridemia managed with insulin

https://doi.org/10.1016/j.jacl.2014.09.004Get rights and content

Highlights

  • 10 cases of extreme hypertriglyceridemia (mean triglyceride 8982 ± 2070 mg/dL) managed by insulin.

  • Compared effectiveness of combined fasting and intravenous insulin approach with intravenous insulin alone.

  • Extreme hypertriglyceridemia is commonly associated with type 2 diabetes.

Abstract

Extreme hypertriglyceridemia can lead to acute pancreatitis and rapid lowering of serum triglycerides (TG) is necessary for preventing such life-threatening complications. However, there is no established consensus on the acute management of extreme hypertriglyceridemia. We retrospectively reviewed 10 cases of extreme hypertriglyceridemia with mean serum TG on presentation of 101.5 ± 23.4 mmol/L (8982 ± 2070 mg/dL) managed with insulin. Serum TG decreased by 87 ± 4% in 24 hours in those patients managed with intravenous insulin and fasting and 40 ± 8.4% in those managed with intravenous insulin alone (P = .0003). The clinical course was uncomplicated in all except 1 patient who subsequently developed a pancreatic pseudocyst. Thus, combination of intravenous insulin with fasting appears to be an effective, simple, and safe treatment strategy in immediate management of extreme hypertriglyceridemia.

Section snippets

Methods

We retrospectively reviewed cases of extreme HTG (serum TG level ≥50 mmol/L) (≥4428 mg/dL) presented to our institution between January 2010 and December 2013. Cases were identified from a list of inpatients for which an endocrinology consult was sought. A detailed medical records review was conducted to identify baseline epidemiological and clinical characteristics of these patients and the type and effectiveness of treatment modalities used in acute management of extreme HTG. Ethics approval

Results

Ten patients presented with extreme HTG (serum TG level ≥50 mmol/L) between January 2010 and December 2013. Half of them (5) presented with pancreatitis. Mean serum TG level on presentation was 101.5 ± 23.4 mmol/L (112.9 ± 19.6 mmol/L in patients with pancreatitis and 90.2 ± 21.6 mmol/L in patients without pancreatitis; P = .09). The median age of the cohort was 39 years (range 24 to 55) and 9 of 10 patients were men. The group was multiethic with majority being Caucasians (6 of 10 cases), 1

Discussion

Options for immediate management of extreme HTG include insulin (IV/subcutaneous), heparin (IV/subcutaneous), and/or plasmapheresis.1 In this study, we found that extreme HTG can be managed effectively and safely with IV insulin. Several case reports have also mentioned use of IV insulin in acute management of severe HTG.5, 6, 7, 8 In the largest report of 15 patients with a less severe degree of HTG (serum triglyceride levels ranged from 11 to 48 mmol/L), the mean reduction in TG by IV insulin

Conclusions

Extreme HTG is commonly associated with poorly controlled type 2 diabetes. Combination of IV insulin and fasting appears to be a very effective, simple, and safe treatment strategy in immediate management of extreme HTG.

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Source of Funding: None.

Conflict of Interest: Nothing to declare.

View full text