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Program

Emergency Medicine

Training Level

Resident PGY 4

Institution

Henry Ford Macomb

Abstract

The incidence of acute pancreatitis has increased over the years, with gallstones and alcohol abuse being the leading causes of pancreatitis. Seven-percent of the cases of pancreatitis are attributed to hypertriglyceridemia. The diagnosis is often missed secondary to coexisting factors such as medications and alcohol abuse1. Treatment options include bowel rest, intravenous fluids, insulin drip, and plasmapheresis. A 55-year-old female presented to the ED with epigastric abdominal pain radiating to her back, nausea, vomiting and diarrhea. Patient denied any melena, hematochezia, or hematemesis. Patient denied alcohol abuse, no history of alcohol abuse is noted in the EMR. Denied recent travel or recent antibiotic use. Patient did not take prescription medications. Initial vitals were significant for hypotension and tachycardia. Physical exam revealed that patient was diaphoretic, she had abdominal distention, and epigastgric tenderness with guarding. Labs initially were reported too lipemic. Repeat labs were significant for Lactic 3.9 ALT 99 AST 246 Ca 6.9 Triglycerides 1582 Lipase 2365. ETOH =0.07. CT abdomen/pelvis showed pancreatic necrosis with severe surround fluid and inflammation. Diagnosis of pancreatitis secondary to hypertriglyceridemia and possible alcohol abuse was made. Patient was started on intravenous fluids, Meropenem, and insulin drip. General surgery was consulted. Patient was admitted to the ICU for further monitoring. Subsequently, patient was transferred to Henry Ford Main SICU for higher level of care as patient was not clinically improving. At Henry Ford Main hospital, patient had serial abdominal exams and further testing. Patient was treated conservatively with intravenous fluids and pain management and discharged eight days later. This case demonstrated an example of hypertriglyceridemia-induced pancreatitis –with severe features on CT scan, blood work and vital signs. Additionally, this patient had other coexisting factors – positive ETOH, which is common in many cases. Conservative treatment is preferred, though plasmapheresis is an option. Conservative treatment with intravenous fluids, insulin drip, and bowel rest was used to treat the patient.

Presentation Date

5-2020

A Case of Triglyceride-Induced Pancreatitis

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