Detailed Abstract
[E-poster - Biliary & Pancreas (Pancreas Disease/Surgery)]
[EP 194] Bridging therapeutic frontiers: A case report on severe hypertriglyceridemia-induced acute pancreatitis and the efficacy of plasmapheresis intervention
Varshita Goduguchinta1, Sarah Wagmeister1, Raahi Patel1, Sarayu Goduguchinta2, Tauseef Sarguroh1, Alex Yarbrough1, Varshita Goduguchinta1
Department of Internal Medicine, Franciscan Health, Olympia Fields, Illinois, United States1, Department of Health Sciences, Boston University, Boston, Massachusetts, United States2
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Conclusions : Background: Therapeutic plasma exchange (TPE) is commonly utilized in patients presenting with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) when triglyceride (TG) levels exceed 1000 mg/dL. Case: 40-year-old Caucasian male presented with complaints of severe epigastric abdominal pain similar to prior episode of pancreatitis 7 months prior which was noted to be secondary to hypertriglyceridemia treated with insulin infusion. Work-up upon admission was significant for lipase of 982 and TG of 8020 mg/dL. CT Abdomen/Pelvis revealed acute interstitial edematous pancreatitis along with diffuse hepatic steatosis. He was initiated on insulin infusion for a total of 22 hours and maintenance fluids with D5LR at 200 mL/hr. Given significant elevation in TG, he concurrently underwent urgent TPE, requiring only 1 session as TG dropped to 733 mg/dL, subsequently 360 mg/dL. Discussion: Given the relatively low incidence rate of HTG-AP, very few studies have been pursued to establish a standardized approach to management. Currently, the recommendations from “The American Society of Apheresis” (2019) regarding the use of TPE for hypertriglyceridemia pancreatitis is Grade 1C, further emphasizing the need for further research. Several studies state that there is no difference in mortality benefit between medical management with insulin infusion vs therapeutic plasma exchange (TPE) in addition to medical therapies. In our case, TPE was able to decrease TG levels to below 1000 mg/dL within one session. Further research and meta-analysis of reported cases are needed to help characterize the optimal treatment plan for HTG-AP, especially in regards to insulin infusion alone versus the addition of TPE.
Methods : 0
Results : 0
Conclusions : Background: Therapeutic plasma exchange (TPE) is commonly utilized in patients presenting with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) when triglyceride (TG) levels exceed 1000 mg/dL. Case: 40-year-old Caucasian male presented with complaints of severe epigastric abdominal pain similar to prior episode of pancreatitis 7 months prior which was noted to be secondary to hypertriglyceridemia treated with insulin infusion. Work-up upon admission was significant for lipase of 982 and TG of 8020 mg/dL. CT Abdomen/Pelvis revealed acute interstitial edematous pancreatitis along with diffuse hepatic steatosis. He was initiated on insulin infusion for a total of 22 hours and maintenance fluids with D5LR at 200 mL/hr. Given significant elevation in TG, he concurrently underwent urgent TPE, requiring only 1 session as TG dropped to 733 mg/dL, subsequently 360 mg/dL. Discussion: Given the relatively low incidence rate of HTG-AP, very few studies have been pursued to establish a standardized approach to management. Currently, the recommendations from “The American Society of Apheresis” (2019) regarding the use of TPE for hypertriglyceridemia pancreatitis is Grade 1C, further emphasizing the need for further research. Several studies state that there is no difference in mortality benefit between medical management with insulin infusion vs therapeutic plasma exchange (TPE) in addition to medical therapies. In our case, TPE was able to decrease TG levels to below 1000 mg/dL within one session. Further research and meta-analysis of reported cases are needed to help characterize the optimal treatment plan for HTG-AP, especially in regards to insulin infusion alone versus the addition of TPE.
SESSION
E-poster
E-Session 03/21 ALL DAY