Kamran Rashid Mirza, Ambreen Kamran Mirza.
Observation of Clinical Course and Response to Conservative Management in patients with Hypertriglyceridemic Acute Pancreatitis Admitted to Medical Ward.
Esculapio J Services Inst Med Sci Jan ;15(1):24-9.

Objective: To study the characteristics and clinical course of hypertriglyceridemic acute pancreatitis patients admitted under care of medical department and observed the effects of conservative management on triglyceride levels. Methods: Patients presenting with mild to moderate acute pancreatitis having admission triglyceride levels more than 11.3mmol/l (1000 mg/dl), normal biliary anatomy and absent gall stones were included. They were closely monitored clinically as well as with serial pancreatic enzymes and triglyceride levels. Initially, the patients were started on conservative regimen including NPO, IV fluids, insulin infusion and anti-lipid medications. Plasmapheresis considered as a non-conservative intervention was not done immediately on admission, but was reserved for the cases showing lack of improvement, worsening of symptoms or lack of reduction in triglyceride levels within 24 to 48 hours of starting treatment. Results: Twelve patients over the period of five years were studied, including nine males and three females. Diabetes turned out to be main cause of hypertriglyceridemia (nine out of 12 patients were known diabetic, and two were newly diagnosed during this admission). Patients with diabetes were found to be poorly compliant with their treatment and monitoring of blood sugar levels. All patients were either overweight or obese, BMI ranged from 27.8 to 35.5 Kg/m2.Fourpatients gave history of alcohol intake and two had hypothyroidism. Five patients were known to be dyslipidemic but none of the patients were aware of any family history of hyperlipidemia. Three patients needed plasmapheresis due to systemic complications and persistent pain whereas, the remaining patients improved with conservative management only. Triglyceride levels declined rapidly and steadily for almost all patients and average time of discharge was approximately one week. Conclusion: Rising obesity and diabetes can lead to increase in cases of hypertriglyceridemic pancreatitis. Diagnosis can easily be missed if triglyceride levels are not checked on admission, as levels can drop rapidly due to treatment started for acute pancreatitis. Patients should be strongly emphasized for compliance to treatment of diabetes and hyperlipidemia and advised to lose weight to prevent occurrence of these cases.

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