SciELO - Scientific Electronic Library Online

vol.49 número2Solid pseudopapillary epithelial neoplasm - a rare but curable pancreatic tumour in young womenCruveilhier-Baumgarten syndrome - a caveat for surgeons índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados



Links relacionados

  • Em processo de indexaçãoCitado por Google
  • Em processo de indexaçãoSimilares em Google


South African Journal of Surgery

versão On-line ISSN 2078-5151
versão impressa 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.



“Full text available only in PDF format”



1. Toskes PP. Hyperlipidaemic Pancreatitis. Gastroenterol Clin North Am 1990;19:783-791.         [ Links ]

2. Yuan G, Al-SHali KZ, Hegele RA. Hypertriglyceridaemia: its etiology, effects and treatment. CMAJ 2007;176(8):1113-1120.         [ Links ]

3. Kyriakidis AV, Raitsiou B, Sakagianni A, et al. Management of acute severe hyperlipidemic pancreatitis. Digestion 2006;73:259-264.         [ Links ]

4. O'Donoghue DJ. Acute pancreatitis due to nadolol-induced hypertriglyceridaemia. Br J Clin Pract 1989;43(2):74-75.         [ Links ]

5. Steinberg WM, Goldstein SS, Davis ND, et al. Diagnostic assays in acute pancreatitis. A study of sensitivity and specificity. Ann Intern Med 1985;102:576-580.         [ Links ]

6. Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut 1984;25:1340-1346.         [ Links ]

7. Yavasoglu I, Kadikoylu G, Bola man Z. Treating hypertriglyceridaemia. CMAJ 2007;177(6):603.         [ Links ]

8. Linares CL, Pelletier AL, Czernichow S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008;37(1):13-22.         [ Links ]

9. Li-Hui Deng, Ping Xue, Qing Xia, et al. Effect of admission hypertriglyceridaemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14(28):4558-4561.         [ Links ]

10. Anderson F, Thomson SR, Clarke DL, et al. Dyslipidaemic pancreattitis clinical assessment and analysis of disease severity and outcomes. Pancreatology 2009;9(3):252-273.         [ Links ]

11. Fortson MR, Sandra MD, Freedman N, Webster PD. Clinical assessment of hyperlipidaemic pancreatitis. Am J Gastroenterol 1995;90:2134-2139.         [ Links ]

12. Dunne MJ, Shenkin A, Imrie CW. Misleading hyponatraemia in acute pancreatitis with hyperlipaemia. Lancet 1979;1:211.         [ Links ]

13. Ho KM, Yeo J. Plasmapheresis in the management of pancreatitis related to hypertriglyceridaemia. Anaesth Intensive Care 1999;27(1):117.         [ Links ]

14. Monga A, Arora A, Makkar RPS, Gupta AK. Hypertriglyceridaemia-induced acute pancreatitis- treatment with heparin and insulin. Indian J Gastroenterol 2003;22:102-103.         [ Links ]

15. Alagozlu, Cindoruk M, Karakan T, Unal S. Heparin and insulin in the treatment of hypertriglyceridaemia-induced severe acute pancreatitis. Dig Dis Sci 2006;51:931-933.         [ Links ]

16. Chee-Chuen Loo, Jackie YL Tan. Decreasing the plasma triglyceride level in hypertriglyceridemia-induced pancreatitis in pregnancy: A case report. Am J Obstet Gynecol 2002;187:241-242.         [ Links ]

17. Jain P, Rai RR, Udawat H, et al. Insulin and heparin in treatment of hypertriglyceridemia-inducedpancreatitis. World J Gastroenterol 2007;13(18):2642-2643.         [ Links ]

18. Berger Z, Quera R, Poniachik J, et al. Heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemai. Experience of 5 cases Rev Med Chil 2001;129(12):1373-1378.         [ Links ]

19. Routy J, Smith GHR, Blank DW, Gilfix BM. Plasmapheresis in the treatment of an acute pancreatitis due to protease inhibitor-induced hypertriglyceridemia. J Clin Apheresis 2000;16:157-159.         [ Links ]

20. Yeh J, Chen J, Chiu H. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apheresis 2003;18:181-185.         [ Links ]

21. Jui-Hao Chen, Jiann-Horng Yeh, Hsiin-Wen Lai, Chao-Sheng Liao. Therapeutic plasma exchange in patients with hyperlipidaemic pamncreatitis. World J Gastroentrol 2004;10(15):2272-2274.         [ Links ]

22. Ford P, Breheny F, Jenkins I. Plasmapheresis in the management of pancreatitis related to hypertriglyceridaemia. Anaesth Intensive Care 1998;26(5):598.         [ Links ]

Creative Commons License Todo o conteúdo deste periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons