Case StudieExtreme hypertriglyceridemia managed with insulin
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.
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