Extreme Hypertriglyceridemia Managed with Intravenous Insulin with or without Nil per Oral: Is There a Difference?

Program: Abstracts - Orals, Poster Preview Presentations, and Posters
Session: SUN 0837-0868-Clinical Aspects of Lipid Metabolism and Disease
Clinical
Sunday, June 22, 2014: 1:00 PM-3:00 PM
Hall F (McCormick Place West Building)

Poster Board SUN-0864
Usman H Malabu, MD, FRACP, FACP.1, Moe Thuzar, MD, FRACP2, Vasant V Shenoy, MD, FRACP2, Ryan Schrale, MD, FRACP3 and Kunwarjit Singh Sangla, MBBS, MD, FRACP4
1The Townsville Hospital, Douglas, Australia, 2Townsville Hospital, Australia, 3Townsville Hospital, Townsville, 4Townsville Hospital, Townsville QLD, Australia
Extreme hypertriglyceridemia defined as serum triglyceride (TG) level >50 mmol/l (4425 mg/dl) can lead to acute pancreatitis (1). Rapid lowering of plasma TG is necessary in order to prevent such life threatening complications. However, there is no established guideline on the acute/immediate management of severe hypertriglyceridemia in clinical practice (2). The aim of the study was to review acute management and clinical course of patients with extremely high serum TG at a regional hospital. Ten cases of extreme hypertriglyceridemia admitted at the Australia’s Townsville Hospital between January 2010 and October 2013 were retrospectively reviewed. Age range: 24-55 years. Nine out of the 10 subjects were patients with type 2 diabetes, 3 of them were newly diagnosed. Mean haemoglobin A1C was 12% (108 mmol/mol) and mean random blood glucose at presentation was 324 mg/dl (range: 184-533). Five patients presented with acute pancreatitis. Mean TG at presentation was 100.5 mmol/l (8894 mg/dl). Plasma TG levels decreased by about 80% in the first 24 hours in those patients who were managed with nil per oral (NPO) and intravenous (IV) insulin infusion (n=4) and by about 40% in those treated with IV insulin infusion alone without NPO (n=4). Furthermore, mean daily serum TG was lower in subjects on insulin + NPO compared to patients on insulin alone 9.5 vs 33.8 mmol/l (841 vs 2991 mg/dl), p=0.0002; CI: 13.0-38.3. The clinical course was uncomplicated in all except one patient who subsequently developed a pancreatic pseudocyst. Thus, poorly controlled type 2 diabetes is a common trigger for extreme hypertriglyceridemia. Combination of NPO and IV insulin is an effective, simple and safe treatment strategy in immediate management of severe hypertriglyceridemia. Further prospective studies on a larger population are needed to confirm our findings.

  1. Ewald N, Hardt PD, Kloer H. Severe hypertriglyceridemia and pancreatitis: presentation and management. Curr Opin Lipidol 2009;20:497-504.

  2. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.

Nothing to disclose: UHM, MT, VS, RS, KSS

Source of research support: James Cook University Australia research grant JCU/MRU 092010/528.

Nothing to Disclose: UHM, MT, VVS, RS, KSS

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