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South African Journal of Surgery

versión On-line ISSN 2078-5151
versión impresa ISSN 0038-2361

S. Afr. j. surg. vol.49 no.2 Cape Town abr. 2011




The early management of pancreatitis associated with hypertriglyceridaemia



F. AndersonI; S. Z. MbathaII; S. R. ThomsonIII

IM.Med., F.C.S. (S.A.); Department of Surgery, Addington Hospital and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
IIM.B. Ch.B; Department of Surgery, Addington Hospital and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
IIICh.M., F.R.C.S.; Department of Surgery, Addington Hospital and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban




INTRODUCTION: In triglyceridaemia-associated pancreatitis, decreasing the serum triglyceride level below 5.65 mmol/l alleviates abdominal pain and is purported to improve outcome. We analysed hypertriglyceride level normalisation and outcome in a patient cohort of acute pancreatitis.
PATIENTS AND METHODS: Patients presenting with pancreatitis and hypertriglyceridaemia were assessed. All patients with presenting triglycerides levels >10 mmol/l were assessed for resolution to a level below 5.65 mmol/l at days 3 and 5. Patients with triglyceride levels in excess of 10 mmol/l were treated with either standard supportive therapy or an insulin dextrose infusion.
RESULTS: In the period June 2001 to April 2008, there were 503 admissions of 439 patients with a diagnosis of acute pancreatitis; 26 (6%) had hypertriglyceridaemia >10 mmol/l at admission. Standard therapy was used in all patients; in 6 patients, it was the sole therapy. A dextrose and insulin infusion was used in 20 cases. On day 3, 7 (32%) of the measured triglyceride levels had fallen below 5.65 mmol/l and, on day 5, all but 4 (83%) were <5.65 mmol/l. Three patients died.
CONCLUSION: Standard therapy was equivalent to the use of dextrose and insulin in the resolution of hypertriglyceridaemia. Our methods to reduce triglyceride levels produce morbidity and mortality rates similar to those attained when alternate lipid-lowering strategies are employed.



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