Extreme hypertriglyceridemia managed with insulin

• Published in: Journal of clinical lipidology Vol. 8; no. 6; pp. 630 - 634
• Main Authors: Thuzar, Moe, MBBS, MRCP (UK), FRACP, Shenoy, Vasant V., MD, FRACP, Malabu, Usman H., FRCP, FACP, FRACP, Schrale, Ryan, MSc, FRACP, FCSANZ, FSCAI, FESC, Sangla, Kunwarjit S., MD, FRACP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: Administration, Intravenous; Adult; Cardiovascular; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Disease Progression; Dyslipidemia; Fasting - adverse effects; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hypertriglyceridemia; Hypertriglyceridemia - complications; Hypertriglyceridemia - drug therapy; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Male; Middle Aged; Pancreatic Pseudocyst - etiology; Pancreatitis; Retrospective Studies; Treatment Outcome; Triglycerides - blood; Diabetes; Hypertriglyceridemia; Insulin; Dyslipidemia; Pancreatitis
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2014.09.004

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.