Endocr Pract. 2023 Sep 13:S1530-891X(23)00557-8. doi: 10.1016/j.eprac.2023.09.002. Online ahead of print.
OBJECTIVE: To characterize the time-course of triglyceride (Tg) lowering in hypertriglyceridemic pancreatitis according to initial values, causes, and interventions.
METHODS: Patients hospitalized from October 2013 through December of 2018 with a diagnosis of pancreatitis associated with hypertriglyceridemia (Tg ≥ 500 mg/dL), in absence of other causes, were identified by medical record review. Tg lowering was retrospectively assessed for differences in relation to initial Tg values, use of iv insulin, ethanol vs. non ethanol associated causes, and time to Tg values of < 500 vs < 1000 mg/dL.
RESULTS: Sixty-six cases were identified and 45 had multiple measurements for time-course evaluation. Those with initial Tg values < 4000 mg/dL achieved Tg levels < 1000 mg/dL in < 3 days, while 18.8% with higher values took 5-9 days. Insulin therapy was associated with a longer duration, and ethanol with a shorter duration, of hypertriglyceridemia. Tg clearance in ethanol associated hypertriglyceridemia appeared independent of insulin treatment. Time to Tg < 500 mg/dL vs < 1000 mg/dL was significantly longer when initial Tg levels were > 2000 mg/dL CONCLUSION: A threshold of 4000 mg/dL for initial Tg's in hypertriglyceridemic pancreatitis appears to separate those likely to achieve Tg's < 1000 mg/dL in < 3 vs. > 3 days, independent of cause or treatment. Insulin therapy is appropriate for hyperglycemic patients but appears unnecessary for isolated ethanol associated hypertriglyceridemia. A threshold Tg of < 1000 mg/dL appears more practical than < 500 mg/dL for resuming nutritional intake.