scholarly journals Treatment of Severe Hypertriglyceridemia with Continuous Insulin Infusion

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Yesica Rodríguez Santana ◽  
Andrea Nimo Román ◽  
Iker García Sáez ◽  
José Manuel López Alvarez ◽  
Eduardo Consuegra Llapur ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Insulin Infusion ◽  
Incidental Finding ◽  
Emergency Situation ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Genetic Abnormality ◽  
Severe Hypertriglyceridemia ◽  
Uncontrolled Diabetes ◽  
Continuous Insulin Infusion

Severe hypertriglyceridemia (SH) represents a therapeutic emergency because of the possibility of developing cardiovascular events and hyperlipemic acute pancreatitis (PA). Most patients with SH suffer primary or genetic abnormality in lipid metabolism in combination with a precipitating factor such as uncontrolled diabetes mellitus, alcoholism, and drug intake. The standard treatment of hypertriglyceridemia (HTG) with omega 3 fatty acids and fibrates, along with dietary changes, has no effect on an emergency situation. There are no clinical guidelines to SH, but therapy with insulin, heparin, a combination of both, plasmapheresis, or octreotide have been tested succesfully. We report the case of a 10-year-old girl with clinical acute pancreatitis and diabetic ketoacidosis debut, along with incidental finding of an SH, who had a good outcome after treatment with insulin intravenous infusion.

scholarly journals Severe Familial Hypertriglyceridemia: Successful Treatment With Insulin and a Modified Meal Plan

2018 ◽  
Vol 2 (12) ◽  
pp. 1357-1362
Author(s):  
Ahila Ayyavoo ◽  
Palany Raghupathy ◽  
Meenal Agarwal ◽  
Paul Hofman
Keyword(s):  
Fatty Acids ◽  
Insulin Infusion ◽  
Therapeutic Option ◽  
Medium Chain Triglyceride ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Medium Chain ◽  
Young Infants ◽  
Severe Hypertriglyceridemia ◽  
Meal Plan

Abstract Context Mutations in genes encoding the lipoprotein lipase enzyme, its cofactor, or transport proteins can cause severe familial hypertriglyceridemia, resulting in serious complications, such as severe pancreatitis, hepatosplenomegaly, lipid encephalopathy, and failure to thrive. Current treatment includes a low-saturated-fat formula enriched with high medium-chain triglyceride (TGs), oral fibrates, omega-3 fatty acids, or plasmapheresis. Case Description A 71-day-old infant with very severe hypertriglyceridemia and recurrent pancreatitis associated with a likely pathogenic variant in the LPL gene was treated successfully with insulin infusion and a locally prepared low-fat formula feed after stopping breast milk. Subcutaneous insulin was administered daily from 9 to 30 months of age. His serum TG level was markedly lower, although higher than normal. No episodes of hypoglycemia were noted. Fenofibrate and omega-3 fatty acids were ineffective in this infant. At the last follow-up visit, he was 36 months old and growing normally. He was consuming a special meal plan and receiving insulin injections during high-fat meals. Two other young infants with severe hypertriglyceridemia were growing normally after a short course of insulin infusion and the same modified reduced long chain fat diet. Conclusions Insulin is an unusual and affordable therapeutic option for some patients with severe hypertriglyceridemia and can be helpful in the prevention of acute and chronic complications. Locally available cereals and millets with high crude fiber and a low glycemic index, along with medium chain TGs, was used to prepare an economical special formula at home to maintain TG concentrations in the acceptable limits.

scholarly journals Treatment of Severe Hypertriglyceridemia With Insulin Infusions in Severe COVID-19: A Case Series

2021 ◽  
pp. 089719002110104
Author(s):  
Caitlin M. Thomas ◽  
Martie Vicent ◽  
Shawn Moore ◽  
Fahd Ali ◽  
Leslie Wooten ◽  
...  
Keyword(s):  
Insulin Infusion ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Lipid Lowering ◽  
Optimum Dose ◽  
Infusion Therapy ◽  
Lipid Lowering Therapy ◽  
Omega 3 ◽  
Severe Hypertriglyceridemia ◽  
Continuous Insulin Infusion

Purpose: Rapid onset of severe hypertriglyceridemia was quickly recognized in critical COVID-19 patients. Associated causes have been due to secondary hemophagocytic lymphohystiocytosis (HLH) syndrome, medication-induced, or acute liver failure. Statins, omega-3 polyunsaturated acids, niacin, and fibrates are common oral lipid lowering therapy options in patients at risk for hypertriglyceridemia. The severity of hypertriglyceridemia in COVID-19 patients with triglyceride values reaching greater than 1,000 mg/dL put them at a heightened risk of pancreatitis and therefore an essential need to acutely lower their levels. We present a case series of 5 patients who achieved rapid triglyceride lowering through continuous insulin infusion therapy. Methods: A retrospective chart review of 48 critical COVID-19 patients who were admitted from March 22 to April 15, 2020 was conducted. Inclusion criteria consisted of mechanical ventilation and continuous insulin infusion to treat severe hypertriglyceridemia resulting with 5 eligible patients in this case report. Results and Conclusion: In addition to standard oral lipid lowering therapies, continuous insulin infusion successfully treated severe hypertriglyceridemia in critically ill COVID-19 patients. None of the patients experienced pancreatitis or hypoglycemia necessitating cessation of insulin. Further studies are needed to show the optimum dose and duration of insulin infusion as monotherapy and in combination with oral therapies.

Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis

2020 ◽  
Vol 39 (9) ◽  
pp. 2686-2694
Author(s):  
Daniel R.J. Wolbrink ◽  
Jessica R. Grundsell ◽  
Ben Witteman ◽  
Marcel van de Poll ◽  
Hjalmar C.van Santvoort ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fatty Acids ◽  
Acute Pancreatitis ◽  
Meta Analysis ◽  
Omega 3 Fatty Acids ◽  
Omega 3

scholarly journals Hypertriglyceridemia-associated acute pancreatitis: Response to continuous insulin infusion

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260495
Author(s):  
Vishnu Priya Pulipati ◽  
Ambika Amblee ◽  
Sara Elizabeth T. Yap ◽  
Hafeez Shaka ◽  
Bettina Tahsin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Alcohol Use ◽  
Retrospective Analysis ◽  
Insulin Infusion ◽  
Multivariable Analysis ◽  
Serum Triglycerides ◽  
Rate Of Decline ◽  
Continuous Insulin Infusion

Objective To assess the response of serum triglycerides (TG) to continuous insulin infusion (CII) in adults with hypertriglyceridemia-associated acute pancreatitis (HTGP). Methods Retrospective analysis of TG response to standardized CII therapy in 77 adults admitted to intensive care with TG >1000 mg/dL and HTGP. Results Participants had initial TG 3869.0 [2713.5, 5443.5] mg/dL and were 39.3 ± 9.7 years old, 66.2% males, 58.4% Hispanic, BMI 30.2 [27.0, 34.8] kg/m2, 74.0% with diabetes mellitus (DM) and 50.6% with excess alcohol use. TG-goal, defined as ≤1,000 ± 100 mg/dL, was achieved in 95%. Among the 73 TG-goal achievers (responders), 53.4% reached TG-goal in <36 hours after CII initiation (rapid responders). When compared to slow responders taking≥36 hours, rapid responders had lower initial TG (2862.0 [1965.0, 4519.0] vs 4814.5 [3368.8, 6900.0] mg/dL), BMI (29.4 [25.9, 32.8] vs 31.9 [28.2, 38.3] kg/m2), DM prevalence (56.4 vs 94.1%), and reached TG-50% (half of respective initial TG) faster (12.0 [6.0, 17.0] vs 18.5 [13.0, 32.8] hours). Those with DM (n = 57) vs non-DM (n = 20) were obese (31.4 [28.0, 35.6] vs 27.8 [23.6, 30.3] kg/m2), took longer to reach TG-final (41.0 [25.0, 60.5] vs 14.5 [12.5, 25.5] hours) and used more daily insulin (1.7 [1.3, 2.1] vs 1.1 [0.5, 1.9] U/kg/day). Among those with DM, the rapid responders had higher daily use of insulin vs slow responders 1.9 [1.4, 2.3] vs 1.6 [1.1, 1.8] U/kg/day. All results significant. In multivariable analysis, predictors of faster TG response were absence of DM, lower BMI and initial TG. Conclusion CII was effective in reaching TG-goal in 95% of patients with HTGP. Half achieved TG-goal within 36 hours. Presence of DM, higher BMI and initial TG slowed the time to reach TG-goal. These baseline parameters and rate of decline to TG-50% may be real-time indicators to initiate and adjust the CII for quicker response.

scholarly journals Hypertriglyceridemia-induced acute pancreatitis with diabetic ketoacidosis: A rare presentation of type 1 diabetes mellitus

2017 ◽  
Vol 9 (04) ◽  
pp. 329-331 ◽  
Author(s):  
Prabhat Kumar ◽  
Abhishek Sakwariya ◽  
Amit Ranjan Sultania ◽  
Renu Dabas
Keyword(s):  
Diabetes Mellitus ◽  
Acute Pancreatitis ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Rare Presentation ◽  
Chronic Hyperglycemia ◽  
Severe Hypertriglyceridemia ◽  
Peptide Level

AbstractDiabetic ketoacidosis (DKA) is a frequently encountered complication of diabetes mellitus. DKA is an insulin deficit state and results in moderate to severe hypertriglyceridemia (HTG). HTG is the third leading cause of acute pancreatitis (AP) and often goes unnoticed. The triad of DKA, HTG, and AP is rarely seen, and literature on the same is sparse. We report a case of AP which was due to DKA-induced secondary HTG in an adult with previously undiagnosed type 1 diabetes. His HbA1c was significantly raised, and C-peptide level was low, confirming chronic hyperglycemia. He was treated successfully with insulin infusion, intravenous crystalloid, and analgesics.

APOC-III Antisense Oligonucleotides: A New Option for the Treatment of Hypertriglyceridemia

2018 ◽  
Vol 25 (13) ◽  
pp. 1567-1576 ◽  
Author(s):  
Joel Schmitz ◽  
Ioanna Gouni-Berthold
Keyword(s):  
Antisense Oligonucleotides ◽  
Clinical Evidence ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Loss Of Function ◽  
Phase 3 ◽  
Gene Encoding ◽  
Apolipoprotein Ciii ◽  
Severe Hypertriglyceridemia ◽  
Increased Risk

Elevated triglyceride levels (higher than ~1000 mg/dL) are associated with an increased risk for pancreatitis. Apolipoprotein-CIII (apoC-III) plays a key role in the metabolism of triglycerides and triglyceride-rich lipoproteins. Loss of function mutations in the gene encoding apoC-III (APOC3) is associated with low triglyceride levels and a decreased risk for cardiovascular disease (CVD) while overexpression of APOC3 is associated with hypertriglyceridemia. Although many drugs such as fibrates, statins and omega-3 fatty acids modestly decrease triglyceride levels (and apoC-III concentrations), there are many patients who still have severe hypertriglyceridemia and are at increased risk for pancreatitis and potentially for CVD. The antisense oligonucleotide (ASO) against APOC3 mRNA volanesorsen (previously called ISIS 304801, ISIS-ApoCIIIRx and IONIS-ApoCIIIRx) robustly decreases both, apoC-III production and triglyceride concentrations and is being currently evaluated in phase 3 trials. In this narrative review, we present the currently available clinical evidence on the efficacy and safety of volanesorsen for the treatment of hypertriglyceridemia.

scholarly journals Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Vijay Gayam ◽  
Amrendra Kumar Mandal ◽  
Pavani Garlapati ◽  
Mazin Khalid ◽  
Arshpal Gill ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Insulin Infusion ◽  
Term Treatment ◽  
Recurrent Acute Pancreatitis ◽  
Nasogastric Feeding ◽  
Long Term Treatment ◽  
History Of ◽  
Laboratory Investigations ◽  
Continuous Insulin Infusion

Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL.

Estimating Health and Economic Benefits from Using Prescription Omega-3 Fatty Acids in Patients With Severe Hypertriglyceridemia

2011 ◽  
Vol 108 (5) ◽  
pp. 691-697 ◽  
Author(s):  
Stuart Samuel ◽  
Barbara Peskin ◽  
Bhakti Arondekar ◽  
Peter Alperin ◽  
Susan Johnson ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Economic Benefits ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Severe Hypertriglyceridemia
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