Severe hypertriglyceridemia and acute pancreatitis, approach and therapies available

Severe hypertriglyceridemia is a condition defined by triglycerides greater than 885 mg/dl. It is more frequently associated with uncontrolled secondary causes that promote triglycerides elevation. It has different clinical manifestations, where acute pancreatitis is the most feared due to its high mortality. We present a retrospective case series of ten adult patients (including a pregnant woman), hospitalized with severe hypertriglyceridemia with values from 1.019 mg/dLto 7.812 mg/dL. The most frequent comorbidities were arterial hypertension, type 2 diabetes mellitus, obesity, mixed dyslipidemia, familial dyslipidemia, and previous pancreatitis. The most frequent complications were acute pancreatitis, recurrent pancreatitis, de novo type 2 diabetes mellitus, and acute myocardial infarction.
80% of the patients went to the intensive care unit. Initially, the treatment was based on immediate fibrate initiation and transient fasting to prevent new triglycerides formation, but also to prevent pancreatic enzymes activation, and the associated symptoms such as stomachache, nausea, and vomiting. A low fat and arbohydrates diet was given when triglycerides were stable. In some cases, insulin and heparin intravenous infusions were added, as these medications promote the lipoprotein lipase activity, crucial for triglycerides metabolism. Statins were used mainly in patients with mixed dyslipidemia. We emphasize the importance of reporting these conditions to contribute to clinicians' decision-making in the context of severe hypertriglyceridemia and its complications, including acute pancreatitis because of the little and controversial evidence in this field.