Document Detail


Hypertriglyceridemia-induced acute pancreatitis treated with insulin and heparin.
MedLine Citation:
PMID:  22261942     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: A case of hypertriglyceridemia-induced acute pancreatitis that was managed with insulin and heparin is reported.
SUMMARY: A 39-year-old Hispanic man arrived at the emergency department with complaints of abdominal pain, nausea, and vomiting over one day. A computed tomography scan of the abdomen revealed peripancreatic inflammatory changes surrounding the tail of the pancreas, consistent with pancreatitis. Pertinent laboratory test values on admission were as follows: triglyceride concentration, 5366 mg/dL; total cholesterol concentration, 555 mg/dL; amylase concentration, 131 units/L; lipase concentration, 51 units/L; serum glucose concentration, 253 mg/dL; and serum sodium concentration, 128 mmol/L. The patient was diagnosed with hypertriglyceridemia-induced pancreatitis. On hospital day 1, the patient was given nothing by mouth and received a 1-L bolus dose of 0.9% sodium chloride injection, followed by a continuous infusion of 0.9% sodium chloride injection at a rate of 125 mL/hr. Subcutaneous heparin 5000 units every eight hours, sliding-scale regular insulin, and gemfibrozil 600 mg twice daily were initiated. On hospital day 2, the patient's triglyceride concentration decreased to 2962 mg/dL, and his blood glucose concentration was 147 mg/dL. Subcutaneous insulin detemir 25 units daily was ordered, and sliding-scale insulin was continued. Due to continued elevated triglyceride levels, the patient was transitioned from subcutaneous insulin to an i.v. insulin infusion at 0.1 unit/kg/hr in addition to an infusion of 5% dextrose. On hospital day 5, the patient's triglyceride concentration decreased to 717 mg/dL; the insulin-dextrose infusion was discontinued. The patient was discharged on hospital day 6.
CONCLUSION: A 39-year-old man with pancreatitis caused by severe hypertriglyceridemia was treated with a continuous insulin infusion and subcutaneous heparin.
Authors:
Jennifer D Twilla; Jimmie Mancell
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  69     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-20     Completed Date:  2012-05-09     Revised Date:  2012-08-31    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-6     Citation Subset:  IM    
Affiliation:
Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA. jennifertwilla@mlh.org
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Anticoagulants / administration & dosage,  therapeutic use
Gemfibrozil / therapeutic use
Heparin / administration & dosage,  therapeutic use*
Humans
Hypertriglyceridemia / complications*,  drug therapy,  physiopathology
Hypoglycemic Agents / administration & dosage
Hypolipidemic Agents / therapeutic use
Infusions, Intravenous
Injections, Subcutaneous
Insulin / administration & dosage,  therapeutic use*
Male
Pancreatitis / drug therapy*,  etiology,  physiopathology
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hypoglycemic Agents; 0/Hypolipidemic Agents; 0/Insulin; 25812-30-0/Gemfibrozil; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Am J Health Syst Pharm. 2012 Jul 15;69(14):1187-8   [PMID:  22761068 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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