1
|
Shrestha A, Bam PK, Pandit A, Shrestha H, Koirala M. Eruptive xanthoma as a warning sign of uncontrolled hypertriglyceridemia presenting with acute pancreatitis and uncontrolled type II diabetes mellitus: A case report. Clin Case Rep 2024; 12:e8926. [PMID: 38799544 PMCID: PMC11111605 DOI: 10.1002/ccr3.8926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical Message Managing diabetic ketoacidosis (DKA) in individuals with severe dyslipidemia necessitates a comprehensive approach. While rehydration and continuous insulin infusion are fundamental components of DKA management due to the underlying insulin deficiency, the presence of severe hyperlipidemia with eruptive xanthomas warrants additional consideration. Early initiation of lipid-lowering agents can expedite the resolution of cutaneous lesions and substantially mitigate the risk of severe complications such as pancreatitis, along with attenuating long-term cardiovascular risks. Abstract Xanthomas are the benign lesions which are generated by localized lipid deposits in the skin, tendons, and subcutaneous tissue. They appear clinically as yellowish papules, nodules, or plaques. Acute pancreatitis and eruptive xanthomas can occur as complications of hyperlipidemia. Uncontrolled diabetes mellitus in one of the risk factors for hypertriglyceridemia. Early recognition and treatment of the eruptive xanthomatosis as a warning sign of hypertriglyceridemia can decrease the morbidity and mortality due to acute pancreatitis. Here, we discuss a case of 37-years old female patient with uncontrolled type II diabetes mellitus presented with acute pancreatitis and eruptive xanthomas as result of raised triglycerides and uncontrolled diabetes.
Collapse
Affiliation(s)
- Ankit Shrestha
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Prabin Kumar Bam
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Aakash Pandit
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Hari Shrestha
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| | - Melisha Koirala
- Department of Internal MedicineChitwan Medical CollegeBharatpurNepal
| |
Collapse
|
2
|
Wang J, Xia Y, Cao Y, Cai X, Jiang S, Liao Y, Shi M, Luo H, Wang D. Evaluating the efficacy and timing of blood purification modalities in early-stage hyperlipidemic acute pancreatitis treatment. Lipids Health Dis 2023; 22:208. [PMID: 38031159 PMCID: PMC10685498 DOI: 10.1186/s12944-023-01968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is characterized by a violent cytokine storm-driven inflammation and is associated with a predisposition to severe disease. The treatment strategy for HTG-AP consists mainly of conventional symptomatic and lipid-lowering treatments. For early-stage HTG-AP, blood purification (BP) can rapidly and effectively reduce serum triglyceride and inflammatory cytokine levels, block the development of systemic inflammatory response syndrome, and improve patient outcomes. Currently, the primary modalities for BP in patients with HTG-AP include plasma exchange, hemoperfusion, and hemofiltration. When using BP to treat patients with HTG-AP, a comprehensive analysis incorporating the elevated lipid levels and severity of the patient's condition contributes to the selection of different treatment modes. Moreover, the timing of the treatment is also imperative. Early intervention is associated with a better prognosis for patients with HTG-AP requiring lipid-lowering treatment.
Collapse
Affiliation(s)
- Jianjun Wang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Yang Xia
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Yuan Cao
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Xianfu Cai
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Shichun Jiang
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Yougang Liao
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Mingsong Shi
- Nuclear Medicine Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China
| | - Huiwen Luo
- Nuclear Medicine Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| | - Decai Wang
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China.
| |
Collapse
|
3
|
Cao L, Chen Y, Liu S, Huang W, Wu D, Hong D, Wang Z, Sun Y, Qin K, Guo F, Luo C, Jiao Q, Luo X, Zhou J, Li G, Ye B, Chen T, Liu M, Mao W, Wang L, Li S, Windsor JA, Liu Y, Ke L, Tong Z, Li W. Early Plasmapheresis Among Patients With Hypertriglyceridemia-Associated Acute Pancreatitis. JAMA Netw Open 2023; 6:e2320802. [PMID: 37378979 DOI: 10.1001/jamanetworkopen.2023.20802] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Importance The incidence of hypertriglyceridemia-associated acute pancreatitis (HTG-AP) is increasing. Plasmapheresis is theoretically effective in removing triglyceride from plasma, but whether it confers clinical benefits is unclear. Objective To assess the association between plasmapheresis and the incidence and duration of organ failure among patients with HTG-AP. Design, Setting, and Participants This is an a priori analysis of data from a multicenter, prospective cohort study with patients enrolled from 28 sites across China. Patients with HTG-AP were admitted within 72 hours from the disease onset. The first patient was enrolled on November 7th, 2020, and the last on November 30th, 2021. The follow-up of the 300th patient was completed on January 30th, 2022. Data were analyzed from April to May 2022. Exposures Receiving plasmapheresis. The choice of triglyceride-lowering therapies was at the discretion of the treating physicians. Main Outcomes and Measures The primary outcome was organ failure-free days to 14 days of enrollment. Secondary outcomes included other measures for organ failure, intensive care unit (ICU) admission, duration of ICU and hospital stays, incidence of infected pancreatic necrosis, and 60-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were used to control potential confounders. Results Overall, 267 patients with HTG-AP were enrolled (185 [69.3%] were male; median [IQR] age, 37 [31-43] years), among whom 211 underwent conventional medical treatment and 56 underwent plasmapheresis. PSM created 47 pairs of patients with balanced baseline characteristics. In the matched cohort, no difference was detected concerning organ failure-free days between patients undergoing plasmapheresis or not (median [IQR], 12.0 [8.0-14.0] vs 13.0 [8.0-14.0]; P = .94). Moreover, more patients in the plasmapheresis group required ICU admission (44 [93.6%] vs 24 [51.1%]; P < .001). The IPTW results conformed to the results from the PSM analysis. Conclusions and Relevance In this large multicenter cohort study of patients with HTG-AP, plasmapheresis was commonly used to lower plasma triglyceride. However, after adjusting for confounders, plasmapheresis was not associated with the incidence and duration of organ failure, but with increased ICU requirements.
Collapse
Affiliation(s)
- Longxiang Cao
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Yingjie Chen
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Siyao Liu
- Department of Emergency Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wei Huang
- West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghuang Hong
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Zuozheng Wang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yi Sun
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, China
| | - Kaixiu Qin
- Department of Emergency Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Guo
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Cuizhu Luo
- Department of Critical Care Medicine, Pingxiang People's Hospital, Pingxiang, China
| | - Qinghai Jiao
- Department of Critical Care Medicine, The First Hospital of Handan, Handan, China
| | - Xiang Luo
- Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, The University of Liverpool, Liverpool, United Kingdom
| | - Man Liu
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Lanting Wang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shuai Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - John A Windsor
- Surgical and Translational Research Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| |
Collapse
|
4
|
Cao L, Zhou J, Chen M, Chen T, Liu M, Mao W, Lin J, Hong D, Yao W, Sun Y, Qin K, Guo F, Zhou Y, Jiao Q, Chen Y, Li G, Ye B, Ke L, Tong Z, Liu Y, Li W. The Effect of Plasma Triglyceride-Lowering Therapy on the Evolution of Organ Function in Early Hypertriglyceridemia-Induced Acute Pancreatitis Patients With Worrisome Features (PERFORM Study): Rationale and Design of a Multicenter, Prospective, Observational, Cohort Study. Front Med (Lausanne) 2021; 8:756337. [PMID: 34966749 PMCID: PMC8710509 DOI: 10.3389/fmed.2021.756337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease with multiple etiologies. The prevalence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has been increasing in recent years. It is reported that early triglyceride (TG) levels were associated with the severity of the disease, and TG- lowering therapies, including medical treatment and blood purification, may impact the clinical outcomes. However, there is no consensus regarding the optimal TG-lowering therapy, and clinical practice varies greatly among different centers. Our objective is to evaluate the TG-lowering effects of different therapies and their impact on clinical outcomes in HTG-AP patients with worrisome features. Methods: This is a multicenter, observational, prospective cohort study. A total of approximately 300 patients with HTG-AP with worrisome features are planned to be enrolled. The primary objective of the study is to evaluate the relationship between TG decline and the evolution of organ failure, and patients will be dichotomized depending on the rate of TG decline. The primary outcome is organ failure (OF) free days to 14 days after enrollment. Secondary outcomes include new-onset organ failure, new-onset multiple-organ failure (MOF), new-onset persistent organ failure (POF), new receipt of organ support, requirement of ICU admission, ICU free days to day 14, hospital free days to day 14, 60-day mortality, AP severity grade (Based on the Revised Atlanta Classification), and incidence of systemic and local complications. Generalized linear model (GLM), Fine and Gray competing risk regression, and propensity score matching will be used for statistical analysis. Discussion: Results of this study will reveal the current practice of TG-lowering therapy in HTG-AP and provide necessary data for future trials.
Collapse
Affiliation(s)
- Longxiang Cao
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Mingzhi Chen
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, The University of Liverpool, Liverpool, United Kingdom
| | - Man Liu
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jiyan Lin
- Emergency Department, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Donghuang Hong
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Weijie Yao
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yi Sun
- The Fourth Department of The Digestive Disease Center, Suining Central Hospital, Suining, China
| | - Kaixiu Qin
- Department of Emergency Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Guo
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Zhou
- Department of Critical Care Medicine, Pingxiang People's Hospital, Pingxiang, China
| | - Qinghai Jiao
- Department of Critical Care Medicine, The First Hospital of HanDan, Handan, China
| | - Yingjie Chen
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, China
| | - Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | | |
Collapse
|
5
|
Lin Y, Yu S, Wu X, Huang L, Huang S, Huang Y, Ding J, Li D. Clinical analysis of the therapeutic effect of plasma exchange on hypertriglyceridemic acute pancreatitis: A retrospective study. Transfusion 2021; 62:72-81. [PMID: 34735720 DOI: 10.1111/trf.16724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The therapeutic effect of plasma exchange (PE) on hypertriglyceridemic acute pancreatitis (HTGAP) is unclear. Therefore, we aimed to explore this therapeutic effect. STUDY DESIGN AND METHODS This study included 204 patients with HTGAP who underwent treatment at two provincial tertiary grade A hospitals in Fujian Province from October 2012 to May 2021. Patients were divided into a conventional group and a PE group. The Student's t-test and chi-square test were used for data analysis. RESULTS Among 204 patients, 56 and 148 were included in the PE and conventional groups, respectively. After propensity score matching (PSM), the PE and conventional groups each had 42 patients. There was no significant difference in age; sex; pregnancy; comorbidities; laboratory findings; incidences of complications, and multiple organ dysfunction syndrome (MODS); organ support treatment; surgical rate; mortality; and hospital stay between the groups (p > 0.05). The total expenses were significantly higher in the PE group than in the conventional group (p < 0.05). There was no statistically significant difference in the times of PE; total volume of PE; incidences of complications, and MODS; organ support treatment; surgical rate; mortality; and hospital stay between the early PE and delayed PE groups (p > 0.05). All patients in the PE group and conventional group with acute renal failure had significantly higher D-dimer levels than those without acute renal failure (p < 0.05). DISCUSSION Compared with conventional treatment, PE does not have a better therapeutic effect on HTGAP. The D-dimer level can predict whether patients with HTGAP will have acute renal failure.
Collapse
Affiliation(s)
- Yongxu Lin
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shufang Yu
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaofan Wu
- Department of Tuberculosis Ward 2, Wuhan Pulmonary Hospital, Wuhan, China
| | - Letong Huang
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Simei Huang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yongzhu Huang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian Ding
- Department of Gastroenterology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dan Li
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
6
|
Afzal N, Kausar S. Therapeutic Plasmapheresis: A Treatment Modality in Severe Hypertriglyceridemia in Adolescence. Cureus 2021; 13:e17341. [PMID: 34567882 PMCID: PMC8454459 DOI: 10.7759/cureus.17341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Severe hypertriglyceridemia (SHTG) is defined as plasma triglycerides >1000 mg/dl. It is a rare and understudied condition in children and adolescents. SHTG in pediatric patients may occur as a result of certain genetic disorders of enzymes involved in triglyceride synthesis and metabolism, or it may be seen secondary to uncontrolled diabetes, obesity, metabolic syndrome, or certain medications. SHTG can cause recurrent abdominal pain and acute pancreatitis. Rapid lowering of triglycerides is needed in SHTG to prevent these complications. However, there are no specific guidelines for the treatment of severe hypertriglyceridemia in children and adolescents. Here we report a case of a 16-year-old boy, who was diagnosed with metabolic syndrome three years back. He had a family history of diabetes type 2 and dyslipidemia. In the current case presentation, the patient presented with SHTG-induced acute pancreatitis, who was successfully treated using plasmapheresis. To our knowledge, no such case has ever been reported in Pakistan. Our case findings highlight the use of a less conventional method for the treatment of hypertriglyceridemia in children.
Collapse
Affiliation(s)
- Nayab Afzal
- Chemical Pathology, National Medical Centre, Karachi, PAK
| | - Shamim Kausar
- Intensive Care Unit, National Medical Centre, Karachi, PAK
| |
Collapse
|
7
|
Webb CB, Leveno M, Quinn AM, Burner J. Effect of TPE vs medical management on patient outcomes in the setting of hypertriglyceridemia-induced acute pancreatitis with severely elevated triglycerides. J Clin Apher 2021; 36:719-726. [PMID: 34228372 DOI: 10.1002/jca.21922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) accounts for 1 to 10% of pancreatitis cases, and is associated with a more severe clinical course. Therapeutic plasma exchange (TPE) is a potential treatment option for quickly lowering plasma triglycerides (TG). Current ASFA guidelines define HTG-AP as a Category III disorder, indicating the role of apheresis is not firmly established. Here, we examine clinical data regarding its effectiveness on morbidity and mortality in patients with HTG-AP presenting with severely elevated plasma triglycerides (>4000 mg/dl). METHODS We retrospectively examined clinical data and outcomes from 67 consecutive episodes of HTG-AP over a 5-year period in which either medical management alone or medical management plus adjunct TPE was employed to reduce plasma triglycerides. RESULTS 16/67 admissions involved TPE, initiated at a mean of 0.7 days from the time of presentation, while 51 received medical management alone. After only one TPE procedure, the mean TG values decreased from 4103 to 1045 mg/dl (a reduction of 74.7%), and those receiving TPE reached plasma TG < 1000 mg/dl 0.99 days faster than the medical group. One patient in the TPE group died. However, when excluding patients with hospital courses complicated by multiple organ dysfunction, there was no significant difference in mortality or hospital length of stay (LOS) between the groups. CONCLUSIONS In uncomplicated cases of HTG-AP with an absence of multiorgan dysfunction, there is no significant benefit to either mortality or LOS when adding adjunct TPE to medical management, even when patients present with severely elevated levels of TG.
Collapse
Affiliation(s)
- Christopher B Webb
- Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA
| | - Mathew Leveno
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Andrew M Quinn
- Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA
| | - James Burner
- Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA
| |
Collapse
|
8
|
Özdemir ZN, Şahin U, Yıldırım Y, Kaya CT, İlhan O. Lipoprotein apheresis efficacy and challenges: single center experience. Hematol Transfus Cell Ther 2021; 44:56-62. [PMID: 33745887 PMCID: PMC8885363 DOI: 10.1016/j.htct.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/05/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Lipoprotein apheresis (LA) is an extracorporeal therapy which removes apolipoprotein B-containing particles from the circulation. We evaluated techniques and efficiency of lipoprotein apheresis procedures applied to patients with familial and non-familial hypercholesterolemia (FH) at our center. Methods We retrospectively evaluated 250 LA procedures applied to 27 patients with dyslipidemia between March 2011 and August 2019. Results A total of 27 patients, of whom 19 (70.4%) were male and 8 (29.6%), female, were included. Eighteen (66.7%), 6 (22.2%) and 3 (11.1%) patients were diagnosed with non-FH, homozygous FH (HoFH) and heterozygous FH (HeFH), respectively. Two different apheresis techniques, direct adsorption of lipoproteins (DALI) (48.8%) and double filtration plasmapheresis (DFPP) (51.2%), were used. The change in the serum total cholesterol (TC) level was the median 302 mg/dl (171–604 mg/dl) (60.4%) in HoFH patients, 305 mg/dl (194–393 mg/dl) (60.8%) in HeFH patients and 227 mg/dl (75–749 mg/dl) (65.3%) in non-FH patients. The change in the serum low-density lipoprotein (LDL) level was the median 275 mg/dl (109–519 mg/dl) (64.2%), 232 mg/dl (207–291 mg/dl) (64.5%) and 325 mg/dl (22–735 mg/dl) (70.9%) in patients with HoFH, HeFH and non-FH, respectively. A significantly effective reduction in serum lipid levels, including TC, LDL and triglycerides, was achieved in all patients, regardless of the technique, p < .001. The decrease in the serum TC and LDL levels was significantly higher in the DFPP, compared to the DALI, being 220 mg/dl (−300 to 771) vs 184 mg/dl (64–415), p < .001 and 196 mg/dl (11–712) vs 157 mg/dl (54–340), p < .001, respectively. Conclusions Our results showed that LA is a highly effective treatment in reducing serum lipid levels and safe, without any major adverse event.
Collapse
Affiliation(s)
| | - Uğur Şahin
- Medicana International Ankara Hospital, Ankara, Turkey
| | | | | | - Osman İlhan
- Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
9
|
Secondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis. Am J Med Sci 2021; 361:616-623. [PMID: 33618838 DOI: 10.1016/j.amjms.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/19/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypertriglyceridemia induced acute pancreatitis (HIAP) is the third common cause of acute pancreatitis. HIAP can result in recurrent attacks of severe AP with significant morbidity and mortality. Hypertriglyceridemia (HTG) could be primary or secondary. Although genetic causes of HTG are well studied, the prevalence of secondary causes of HTG in patients presenting with HIAP is not well characterized. This study aimed to identify the prevalence of risk factors for secondary hypertriglyceridemia among patients presenting with HIAP in a tertiary referral center in a large metropolitan area. METHODS This is a retrospective analysis of all patients admitted with AP from August 2012-2017. A subgroup of patients with triglycerides >880 mg/dl were included for analysis. Secondary causes of HTG were identified. Secondary analysis evaluating the severity of pancreatitis was performed. RESULTS There were 3,746 patients admitted for AP of which 57 patients had AP and HTG. Of these 57 patients, 70.2% had history of diabetes mellitus, 26.3% had history of heavy alcohol use, 22.8% had chronic kidney disease, 47.3% with obesity, and 21.1% with metabolic syndrome. Two patients were classified as unexplained HTG. Secondary analysis showed a total of 45.6% of patients requiring ICU admission. 26.3% of patients with severe inflammatory pancreatitis and 17.5% of patients with severe necrotizing pancreatitis. CONCLUSIONS In our cohort of HIAP, 55 out of 57 patients had secondary causes for HTG. Identifying secondary causes of HTG during acute hospitalization is important to tailor outpatient treatment in order to prevent future admissions with HIAP.
Collapse
|
10
|
Chowdhary PK, Kale SA. Plasmapheresis in Hypertriglyceride-induced Pancreatitis: A Series of Four Cases. Indian J Nephrol 2020; 31:299-302. [PMID: 34376949 PMCID: PMC8330650 DOI: 10.4103/ijn.ijn_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 11/04/2022] Open
Abstract
Hypertriglyceride-induced Acute Pancreatitis is a devasting condition. The rapid reduction of serum triglyceride is a key factor in its management. Beside the reduction in Triglyceride level plasmapheresis has other added advantage. Early initiation of plasmapheresis within 48 hrs has a better outcome. Plasmapheresis should be performed until triglyceride levels have been lowered to 500mg/dl. Here, we present a series of four cases of hypertriglyceride induced pancreatitis who underwent plasmapheresis. All the patients were diabetics. All cases showed the rapid reduction of triglyceride levels after plasmapheresis. Three patients were discharge from hospital, where as one patient died due to Sepsis. Out of four patients only one required Renal Replacement therapy.
Collapse
Affiliation(s)
| | - Sanjeev Anant Kale
- Department of Nephrology, Ramkrishan Care Hospital, Raipur C.G., Chhattisgarh, India
| |
Collapse
|
11
|
Nineteen Cases of Severe Acute Pancreatitis in Pregnancy: A 5-Year Single-Center Retrospective Analysis. Pancreas 2020; 49:e54-e55. [PMID: 32590624 DOI: 10.1097/mpa.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
12
|
Maduzia D, Ceranowicz P, Cieszkowski J, Gałązka K, Kuśnierz-Cabala B, Warzecha Z. Pretreatment with Warfarin Attenuates the Development of Ischemia/Reperfusion-Induced Acute Pancreatitis in Rats. Molecules 2020; 25:E2493. [PMID: 32471279 PMCID: PMC7321200 DOI: 10.3390/molecules25112493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022] Open
Abstract
In acute pancreatitis (AP), pancreatic damage leads to local vascular injury, manifesting as endothelial damage and activation, increased vascular permeability, leukocyte rolling, sticking and transmigration to pancreatic tissue as well as activation of coagulation. Previous studies have shown that pretreatment with heparin or acenocoumarol inhibits the development of AP. The aim of the present study was to check the impact of pretreatment with warfarin, an oral vitamin K antagonist, on the development of ischemia/reperfusion-induced AP in rats. AP was induced by pancreatic ischemia followed by reperfusion of the gland. Warfarin (90, 180 or 270 µg/kg/dose) or vehicle were administered intragastrically once a day for 7 days before induction of AP. The effect of warfarin on the severity of AP was assessed 6 h after pancreatic reperfusion. The assessment included histological, functional, and biochemical analyses. Pretreatment with warfarin given at a dose of 90 or 180 µg/kg/dose increased the international normalized ratio and reduced morphological signs of pancreatic damage such as pancreatic edema, vacuolization of acinar cells, necrosis and the number of hemorrhages. These effects were accompanied by an improvement of pancreatic blood flow and a decrease in serum level amylase, lipase, pro-inflammatory interleukin-1β and plasma level of D-dimer. In contrast, pretreatment with warfarin given at a dose of 270 µg/kg/dose led to an increase in severity of pancreatic damage and biochemical indicators of AP. In addition, this dose of warfarin resulted in deaths in some animals. Pretreatment with low doses of warfarin inhibits the development of AP induced by pancreatic ischemia followed by reperfusion.
Collapse
Affiliation(s)
- Dawid Maduzia
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.M.); (J.C.); (Z.W.)
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, 31-034 Cracow, Poland
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.M.); (J.C.); (Z.W.)
| | - Jakub Cieszkowski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.M.); (J.C.); (Z.W.)
| | - Krystyna Gałązka
- Department of Pathology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland;
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Chair of Clinical Biochemistry, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Zygmunt Warzecha
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.M.); (J.C.); (Z.W.)
| |
Collapse
|
13
|
Tabone R, Burstow MJ, Vardesh DL, Yuide PJ, Gundara J, Chua TC. Anti-lipid therapy and risk factor management for triglyceridaemia-induced acute pancreatitis. ANZ J Surg 2020; 90:1997-2003. [PMID: 32190973 DOI: 10.1111/ans.15829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/08/2020] [Accepted: 03/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatitis secondary to hypertriglyceridaemia is rare, accounting for less than 5% of pancreatitis presentations. We reviewed our institutional experience with triglyceridaemia induced acute pancreatitis to report the clinical presentation, patient demographics and clinical management. METHODS The Acute Surgical Unit database at a high-volume general surgical referral centre was queried to identify cases of acute pancreatitis secondary to hypertriglyceridaemia between 2016 and 2019. Patient demographics, clinical manifestations, biochemical derangements and treatment regimens were analysed. Current related literature was reviewed. RESULTS There were 496 presentations for acute pancreatitis of which 14 presentations (2.8%), amongst 12 patients were due to hypertriglyceridaemia. The mean triglyceride level at presentation was 92.46 (standard deviation 46.9) mmol/L. Ten patients (83%) had poorly controlled type 2 diabetes. All patients were managed using conservative therapy combined with a restricted fat diet and commenced on long-term anti-lipid therapy to manage associated risk factors. In addition, 10 patients received an insulin infusion and one patient received insulin infusion, plasmapheresis and heparin infusion in combination. The median length of hospital stay was 5.5 (range 3-13) days. Two patients (16%) developed a recurrent episode related to non-compliance to medical therapy. CONCLUSION Hypertriglyceridaemia is a rare cause of acute pancreatitis. Successful management involves the treatment of acute pancreatitis in conjunction with long-term anti-lipid therapy and optimisation of associated risk factors.
Collapse
Affiliation(s)
- Renee Tabone
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Matthew J Burstow
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Deepak L Vardesh
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Peter J Yuide
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Justin Gundara
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| |
Collapse
|
14
|
Predictability and efficacy of therapeutic plasma exchange for hypertriglyceridemia induced acute pancreatitis. Transfus Apher Sci 2019; 59:102699. [PMID: 32085931 DOI: 10.1016/j.transci.2019.102699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertriglyceridemia induced acute pancreatitis is associated with more severe clinical course than acute pancreatitis caused by other etiologies. Therapeutic plasma exchange (TPE) is a potential treatment for patients with severe hypertriglyceridemia induced acute pancreatitis due to its rapid effect in lowering triglycerides (TG) levels and reducing inflammatory cytokines. However, clinical data regarding the effectiveness and safety of TPE is limited. METHODS We retrospectively reviewed eight cases of hypertriglyceridemia induced acute pancreatitis and treated with TPE. Patients' demographic data, personal history, clinical course, laboratory results, apheresis data and clinical outcome were collected and analyzed. RESULTS At initial presentation, the average TG levels for the eight patients was 3381.6 mg/dl (SD: 1491.6 mg/dl). Twelve procedures were performed on the eight patients in the study, and TG levels decreased by an average of 2673.2 mg/dl (SD: 2306.3 mg/dl) with a corresponding average reduction rate of 60.3 % (SD:21.1 %), ranging from 14.6%-84.9%. A 60 % or greater reduction was achieved in 66.7 % of all the procedures; however, the degree of reduction for each procedure was not predictable, even among repeat procedures on the same patient. CONCLUSIONS Our study indicates that TPE is an effective and safe treatment option for patients with hypertriglyceridemia induced acute pancreatitis. However, due to the unpredictability of TG removal, repeat procedures may be necessary for some patients.
Collapse
|
15
|
Joury A, Alshehri M, Mahendra A, Anteet M, Yousef MA, Khan AM. Therapeutic approaches in hypertriglyceridemia-induced acute pancreatitis: A literature review of available therapies and case series. J Clin Apher 2019; 35:131-137. [PMID: 31724761 DOI: 10.1002/jca.21763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022]
Abstract
Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE.
Collapse
Affiliation(s)
- Abdulaziz Joury
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana.,King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mona Alshehri
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Arjun Mahendra
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mahmoud Anteet
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mohammad A Yousef
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Abdul M Khan
- Department of Pulmonary and Critical Care, Ochsner Clinic Foundation, New Orleans, Louisiana
| |
Collapse
|
16
|
Abstract
Purpose of Review Lipoprotein apheresis is a very efficient but time-consuming and expensive method of lowering levels of low-density lipoprotein cholesterol, lipoprotein(a)) and other apoB containing lipoproteins, including triglyceride-rich lipoproteins. First introduced almost 45 years ago, it has long been a therapy of “last resort” for dyslipidaemias that cannot otherwise be managed. In recent years new, very potent lipid-lowering drugs have been developed and the purpose of this review is to define the role of lipoprotein apheresis in the current setting. Recent Findings Lipoprotein apheresis still plays an important role in managing patients with homozygous FH and some patients with other forms of hypercholesterolaemia and cardiovascular disease. In particular, patients not achieving treatment goals despite modern lipid-lowering drugs, either because these are not tolerated or the response is insufficient. Recently, lipoprotein(a) has emerged as an important cardiovascular risk factor and lipoprotein apheresis has been used to decrease lipoprotein(a) concentrations in patients with marked elevations and cardiovascular disease. However, there is considerable heterogeneity concerning the recommendations by scientific bodies as to which patient groups should be treated with lipoprotein apheresis. Summary Lipoprotein apheresis remains an important tool for the management of patients with severe drug-resistant dyslipidaemias, especially those with homozygous FH.
Collapse
Affiliation(s)
- Gilbert Thompson
- Department of Metabolic Medicine, Imperial College London, Hammersmith Hospital, Ducane Road, London, W12 0NN, UK.
| | - Klaus G Parhofer
- Medical Dept. IV - Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
17
|
Kandemir A, Coşkun A, Yavaşoğlu İ, Bolaman Z, Ünübol M, Yaşa MH, Kadıköylü G. Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis: the 33 cases experience from a tertiary reference center in Turkey. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 29:676-683. [PMID: 30289402 DOI: 10.5152/tjg.2018.17627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis. In patients with severe HTG (TG level>1000 mg/dL), it may be beneficial to immediately lower the levels of triglyceride (TG) and chylomicrons. In this study, we present one of the largest case series on the use of therapeutic plasma exchange (TPE) for hypertriglyceridemia-induced acute pancreatitis (HTG-AP). MATERIALS AND METHODS Overall, 33 patients who were admitted to our clinic for HTG-AP and underwent TPE between January 2007 and July 2017 were included in the study. Clinical data and outcomes and the reduction of triglyceride levels were examined retrospectively. RESULTS The TG level decreased by 54.4%, and the total cholesterol level decreased by 52.1% after one TPE session. The TG decrease after the second TPE session was found to be 79.4%. There were 20 (60.6%) patients with mild acute pancreatitis, 10 (30.3%) patients with moderetaly severe acute pancreatitis, and 3 (9.1%) patients with severe acute pancreatitis based on the categorization according to the revised Atlanta criteria. Regarding local complications, the acute peripancreatic fluid collection was observed in 13 (39.4%) patients, acute necrotic collection was observed in 1 (3%) patient, walled-off necrosis was observed in 1 (3%) patient, and pancreatic pseudocyst was not observed in any patient. Mortality was not determined in patients with mild and moderately severe acute pancreatitis, and its rate was 33.3% in patients with severe acute pancreatitis. The overall mortality rate was 3%. No significant complications related to TPE were noted. CONCLUSION TPE is a safe and helpful therapeutic treatment method for patients with HTG-AP and may be considered particularly in patients with severe acute pancreatitis.
Collapse
Affiliation(s)
- Altay Kandemir
- Department of Gastroenterology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Adil Coşkun
- Department of Gastroenterology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - İrfan Yavaşoğlu
- Department of Hematology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Zahit Bolaman
- Department of Hematology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Mustafa Ünübol
- Department of Endocrinology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Mehmet Hadi Yaşa
- Department of Gastroenterology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | | |
Collapse
|
18
|
Mehta SP, Tiwari AK, Puri R, Arora D, Aggarwal G, Ratan A. Severe hypertriglyceridemia-induced pancreatitis successfully managed with therapeutic plasma exchange: Report from India. Asian J Transfus Sci 2019; 12:154-156. [PMID: 30692801 PMCID: PMC6327775 DOI: 10.4103/ajts.ajts_86_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypertriglyceridemia (HTG) is the third most significant risk factor for acute pancreatitis after gallstones and alcohol. Therapeutic plasma exchange (TPE) has been considered a possible treatment for HTG-induced pancreatitis, especially in severe and refractory cases. Here, we report one such clinical experience with a patient of severe HTG-induced pancreatitis. He was treated with TPE along with intravenous insulin, statins, and fibrates. TPE resulted in immediate relief of symptoms as well as a marked improvement in laboratory values, with 74.5% reduction in triglycerides after a single session. TPE can be successfully utilized as an adjunct in HTG-induced pancreatitis.
Collapse
Affiliation(s)
- Swati Pabbi Mehta
- Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Aseem Kumar Tiwari
- Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Rajesh Puri
- Department of Gastroenterology and Hepatology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Dinesh Arora
- Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Geet Aggarwal
- Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ankita Ratan
- Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| |
Collapse
|
19
|
Adiamah A, Psaltis E, Crook M, Lobo DN. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr 2018; 37:1810-1822. [PMID: 29056284 DOI: 10.1016/j.clnu.2017.09.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aims of this systematic review were to define the epidemiology and pathophysiology of hyperlipidaemic pancreatitis, establish its association with clinical outcome and define management strategies. METHODS The Cochrane, Embase and Medline databases were searched, limited to the last decade, for articles on hyperlipidaemic pancreatitis. All randomised controlled trials, observational studies and case series (with a minimum of 10 patients) on hyperlipidaemic pancreatitis were included. RESULTS Thirty-eight studies with 1979 patients were included. The median admission triglyceride concentration was 42.8 mmol/L (range 13.6-108.6 mmol/L) [3785 mg/dL (range 1205-9612 mg/dL)]. Severe hypertriglyceridaemia (>1000 mg/dL, 11.0 mmol/L) was present in 1.7% of the adult population, and about 15-20% of these developed hyperlipidaemic acute pancreatitis. Medical management of severe hyperlipidaemia at onset of acute pancreatitis has not been investigated fully. However, tight regulation of triglyceride concentration after presentation with acute pancreatitis was found to reduce the risk of recurrence. Plasmapheresis reduced concentrations of triglycerides by up to 85%, but this did not impact morbidity or mortality. All studies included defined hyperlipidaemia as a more severe form of pancreatitis. CONCLUSION The available evidence suggests an increasing risk of acute pancreatitis in patients with hyperlipidaemia and a more severe form of pancreatitis. There is some evidence to suggest biochemical benefit of using novel techniques like plasmapheresis without the desired physiological benefit. However, there is a need for an international consensus on the management of hyperlipidaemic pancreatitis. More rigorous and methodologically robust studies are required to inform such consensus guidelines.
Collapse
Affiliation(s)
- Alfred Adiamah
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Emmanouil Psaltis
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Martin Crook
- Department of Clinical Biochemistry, Guy's and St. Thomas' Hospital NHS Trust, London SE1 9RT, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
| |
Collapse
|
20
|
Management of Hypertriglyceridemia Induced Acute Pancreatitis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4721357. [PMID: 30148167 PMCID: PMC6083537 DOI: 10.1155/2018/4721357] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 02/06/2023]
Abstract
Hypertriglyceridemia is an uncommon but a well-established etiology of acute pancreatitis leading to significant morbidity and mortality. The risk and severity of acute pancreatitis increase with increasing levels of serum triglycerides. It is crucial to identify hypertriglyceridemia as the cause of pancreatitis and initiate appropriate treatment plan. Initial supportive treatment is similar to management of other causes of acute pancreatitis with additional specific therapies tailored to lower serum triglycerides levels. This includes plasmapheresis, insulin, heparin infusion, and hemofiltration. After the acute episode, diet and lifestyle modifications along with hypolipidemic drugs should be initiated to prevent further episodes. Currently, there is paucity of studies directly comparing different modalities. This article provides a comprehensive review of management of hypertriglyceridemia induced acute pancreatitis. We conclude by summarizing our treatment approach to manage hypertriglyceridemia induced acute pancreatitis.
Collapse
|
21
|
Shao Z. SPATHOLOBUS SUBERECTUS STEM EXTRACT IMPROVES THE PROTECTIVE EFFECT OF HEPARIN ON CERULEIN-INDUCED PANCREATITIS. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017; 14:187-193. [PMID: 28480430 PMCID: PMC5412224 DOI: 10.21010/ajtcam.v14i3.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The present study evaluates the effect of Spatholobus suberectus stem extract (SS) in the management of pancreatitis alone and in combination with heparin. MATERIAL AND METHODS Pancreatitis was induced pancreatitis by cerulean (50μg/kg, i.p.) five times at an interval of 1 h without any pretreatment of drug. Rats were treated with SS (100 and 200 mg/kg, p. o.) and heparin (150 U/kg, i.p.) alone and in combination for the duration of a week. Later pancreatic weight and blood flow was estimated and different biochemical parameters like concentration of D-dimer and Interleukin 1β (IL-Ιβ) and activity of amylase and lipase were determined in blood of pancreatitis rats. Moreover effect of drug treatment on DNA synthesis and histopathology was also estimated on cerulean induced pancreatitis rats. RESULT Results of this study suggest that treatment with SS alone and in combination with heparin significantly increase in prothrombin time and pancreatic blood flow than negative control group. There was significant decrease in concentration of IL-Ιβ and D-dimer and activity of amylase and lipase in SS and heparin treated group than negative control group. Pancreatic DNA synthesis was also found to be reduced in SS and heparin alone and in combination treated group. Histopathology study also reveals that treatment with SS and heparin alone and in combination reduces edema, hemorrhages, leukocyte infiltration in the TS of pancreatic tissues. CONCLUSION Present study concludes that treatment with SS alone effectively manages the pancreatitis by ceasing the inflammatory pathway and potentiates the effect of heparin in the management of pancreatitis.
Collapse
Affiliation(s)
- Zhengyi Shao
- Department of Emergency, Beijing Tongren hospital, Affiliated to the Capital Medical University Beijing 100176, China
| |
Collapse
|
22
|
Therapeutic Effect of Low Doses of Acenocoumarol in the Course of Ischemia/Reperfusion-Induced Acute Pancreatitis in Rats. Int J Mol Sci 2017; 18:ijms18040882. [PMID: 28430136 PMCID: PMC5412463 DOI: 10.3390/ijms18040882] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 12/17/2022] Open
Abstract
Intravascular activation of coagulation is observed in acute pancreatitis and is related to the severity of this inflammation. The aim of our study was to evaluate the impact of acenocoumarol therapy on the course of acute pancreatitis induced in male rats by pancreatic ischemia followed by reperfusion. Acenocoumarol at a dose of 50, 100, or 150 µg/kg/dose was administered intragastrically once a day, starting the first dose 24 h after the initiation of pancreatic reperfusion. Results: Histological examination showed that treatment with acenocoumarol reduces pancreatic edema, necrosis, and hemorrhages in rats with pancreatitis. Moreover, the administration of acenocoumarol decreased pancreatic inflammatory infiltration and vacuolization of pancreatic acinar cells. These findings were accompanied with a reduction in the serum activity of lipase and amylase, concentration of interleukin-1β, and plasma d-Dimer concentration. Moreover, the administration of acenocoumarol improved pancreatic blood flow and pancreatic DNA synthesis. Acenocoumarol given at a dose of 150 µg/kg/dose was the most effective in the treatment of early phase acute pancreatitis. However later, acenocoumarol given at the highest dose failed to exhibit any therapeutic effect; whereas lower doses of acenocoumarol were still effective in the treatment of acute pancreatitis. Conclusion: Treatment with acenocoumarol accelerates the recovery of ischemia/reperfusion-induced acute pancreatitis in rats.
Collapse
|
23
|
Joglekar K, Brannick B, Kadaria D, Sodhi A. Therapeutic plasmapheresis for hypertriglyceridemia-associated acute pancreatitis: case series and review of the literature. Ther Adv Endocrinol Metab 2017; 8:59-65. [PMID: 28507728 PMCID: PMC5415006 DOI: 10.1177/2042018817695449] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/02/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe hypertriglyceridemia (HTG) is the third leading cause of acute pancreatitis (AP) in the United States. The current standard of care includes management of HTG using pharmacological therapy. More recently, plasmapheresis has been proposed as a therapeutic tool for decreasing triglyceride (TG) levels, especially in critically ill patients. Few studies are available to ascertain overall benefits of plasmapheresis over traditional management. OBJECTIVE To analyze the outcomes of patients treated with plasmapheresis for severe HTG-associated pancreatitis. METHODS We conducted a retrospective chart review of three patients with severe HTG- associated (TGs greater than 1000 mg/dl; 11.29 mmol/l) AP at the Methodist University Hospital. All the patients underwent plasmapheresis as part of their treatment. RESULTS The average TG level before plasmapheresis was 3532 mg/dl (range: 2524-4562 mg/dl; 39.9 mmol/l; range: 28.5-51.6 mmol/l). All patients made a full recovery, with a significant improvement in TG levels after plasmapheresis. The mean number of sessions was 1.3 (range 1-2), and mean TG level after plasmapheresis was 1051 mg/dl (range: 509-1771 mg/dl; 11.9 mmol/l; range: 5.8-20 mmol/l). After the first session, the average reduction of TG level was 2481 mg/dl (range 753-3750 mg/dl; 28 mmol/l; range: 8.5-42.4 mmol/l) or approximately 70%. None of the patients developed complications related to plasmapheresis. CONCLUSIONS Plasmapheresis can be an effective and rapid treatment option in patients with severe HTG and complications. However, further research, including randomized controlled studies, is necessary.
Collapse
Affiliation(s)
- Kiran Joglekar
- Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Ben Brannick
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Dipen Kadaria
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | |
Collapse
|
24
|
Rivers E, Reynolds BC, Bunn S, Leech NJ, Straker J, Lambert HJ. Acute Pancreatitis Secondary to Severe Hypertriglyceridaemia in a Patient with Type 1a Glycogen Storage Disease: Emergent Use of Plasmapheresis. JIMD Rep 2017; 42:1-4. [DOI: 10.1007/8904_2017_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 09/21/2017] [Accepted: 09/29/2017] [Indexed: 11/24/2022] Open
|
25
|
Wang G, Su C, Yin T. Paclitaxel and platinum-based chemotherapy results in transient dyslipidemia in cancer patients. Mol Clin Oncol 2016; 6:261-265. [PMID: 28357107 DOI: 10.3892/mco.2016.1107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/19/2016] [Indexed: 02/05/2023] Open
Abstract
Paclitaxel and cisplatin (TP) are common chemotherapeutic agents extensively used for treating lung and esophageal cancers. The present study reported three patients with transient hypertriglyceridemia (HTG) following TP chemotherapy. Serum triglyceride (TG) levels returned to baseline at chemotherapy intermission. No patient had any history of HTG or any evidence of pancreatitis or other complications of HTG. No regular elevation of any other serum lipids, including cholesterol, high-density lipoprotein and low-density lipoprotein, was observed. However, treatment of mice with TP decreased TG and slightly increased cholesterol. The findings of the present study suggested that TP chemotherapy results in transient dyslipidemia, and physicians must monitor TG levels during chemotherapy to avoid TG-associated complications.
Collapse
Affiliation(s)
- Guoping Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, P.R. China
| | - Chao Su
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, P.R. China
| | - Tao Yin
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|
26
|
Warzecha Z, Sendur P, Ceranowicz P, Dembiński M, Cieszkowski J, Kuśnierz-Cabala B, Olszanecki R, Tomaszewska R, Ambroży T, Dembiński A. Protective Effect of Pretreatment with Acenocoumarol in Cerulein-Induced Acute Pancreatitis. Int J Mol Sci 2016; 17:ijms17101709. [PMID: 27754317 PMCID: PMC5085741 DOI: 10.3390/ijms17101709] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/12/2016] [Accepted: 09/30/2016] [Indexed: 12/16/2022] Open
Abstract
Coagulation is recognized as a key player in inflammatory and autoimmune diseases. The aim of the current research was to examine the effect of pretreatment with acenocoumarol on the development of acute pancreatitis (AP) evoked by cerulein. Methods: AP was induced in rats by cerulein administered intraperitoneally. Acenocoumarol (50, 100 or 150 µg/kg/dose/day) or saline were given once daily for seven days before AP induction. Results: In rats with AP, pretreatment with acenocoumarol administered at the dose of 50 or 100 µg/kg/dose/day improved pancreatic histology, reducing the degree of edema and inflammatory infiltration, and vacuolization of acinar cells. Moreover, pretreatment with acenocoumarol given at the dose of 50 or 100 µg/kg/dose/day reduced the AP-evoked increase in pancreatic weight, serum activity of amylase and lipase, and serum concentration of pro-inflammatory interleukin-1β, as well as ameliorated pancreatic DNA synthesis and pancreatic blood flow. In contrast, acenocoumarol given at the dose of 150 μg/kg/dose did not exhibit any protective effect against cerulein-induced pancreatitis. Conclusion: Low doses of acenocoumarol, given before induction of AP by cerulein, inhibit the development of that inflammation.
Collapse
Affiliation(s)
- Zygmunt Warzecha
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka St., 31-531 Cracow, Poland.
| | - Paweł Sendur
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka St., 31-531 Cracow, Poland.
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Cracow, Poland.
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka St., 31-531 Cracow, Poland.
| | - Marcin Dembiński
- The Second Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Cracow, Poland.
| | - Jakub Cieszkowski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka St., 31-531 Cracow, Poland.
| | - Beata Kuśnierz-Cabala
- Department of Clinical Biochemistry, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Cracow, Poland.
| | - Rafał Olszanecki
- Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland.
| | - Romana Tomaszewska
- Department of Pathology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Cracow, Poland.
| | - Tadeusz Ambroży
- Faculty of Physical Education and Sport, University of Physical Education, 31-571 Cracow, Poland.
| | - Artur Dembiński
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka St., 31-531 Cracow, Poland.
| |
Collapse
|
27
|
Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. Systematic review of hypertriglyceridemia-induced acute pancreatitis: A more virulent etiology? Pancreatology 2016; 16:469-76. [PMID: 27012480 DOI: 10.1016/j.pan.2016.02.011] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/02/2016] [Accepted: 02/19/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We sought to define the severity and natural history of hypertriglyceridemia induced acute pancreatitis (HTG-AP), specifically whether HTG-AP causes more severe AP than that caused by other etiologies. METHODS Systematic review of the English literature. RESULTS Thirty-four studies (15 countries; 1972-2015) included 1340 HTG-AP patients (weighted mean prevalence of 9%). The median admission triglyceride concentration was 2622 mg/dl (range 1160-9769). Patients with HTG have a 14% weighted mean prevalence of AP. Plasmapheresis decreased circulating triglycerides, but did not conclusively affect AP mortality. Only 7 reports (n = 392 patients) compared severity of HTG-AP to that of AP from other etiologies. Of these, 2 studies found no difference in severity, while 5 suggested that HTG-AP patients may have increased severity compared to AP of other etiology. CONCLUSIONS 1) hypertriglyceridemia is a relatively uncommon (9%) cause of acute pancreatitis; however, patients with hypertriglyceridemia have a high (14%) incidence of acute pancreatitis; 2) plasmapheresis may offer specific therapy unique to this patient population; and 3) data specifically comparing the severity of HTG-AP with AP caused by other etiologies are heterogeneous and scarce.
Collapse
Affiliation(s)
- Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin J Rejowski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory A Cote
- Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Henry A Pitt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| |
Collapse
|
28
|
Zheng Y, Hu W, Wang J, Hu W, Liu C. Plasmapheresis for the treatment of hypertriglyceridemia-induced severe acute pancreatitis in pregnancy: it could be a good choice. Int J Colorectal Dis 2015; 30:1443-4. [PMID: 25665515 DOI: 10.1007/s00384-015-2137-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Yongke Zheng
- Intensive Care Unit, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, China.
| | - Weihang Hu
- Intensive Care Unit, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, China
| | - Jianrong Wang
- Intensive Care Unit, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, China
| | - Wei Hu
- Intensive Care Unit, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, China
| | - Changwen Liu
- Intensive Care Unit, Hangzhou First People's Hospital, No. 261 Huansha Road, Hangzhou, 310006, China
| |
Collapse
|
29
|
Sun S, He L, Bai M, Liu H, Li Y, Li L, Yu Y, Shou M, Jing R, Zhao L, Huang C, Wang H. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study. Ann Saudi Med 2015; 35:352-8. [PMID: 26506968 PMCID: PMC6074380 DOI: 10.5144/0256-4947.2015.352] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The evidence for high-volume hemofiltration plus hemoperfusion (HVHF&HP) for hyperlipidemic severe acute pancreatitis (HL-SAP) is anecdotal. The purpose of our study was to evaluate the efficacy of HVHF&HP for HL-SAP in a prospective controlled study. DESIGN AND SETTING Prospective controlled pilot study between May 2010 and May 2013 in a hospital intensive care unit. PATIENTS AND METHODS HL-SAP patients chose conventional treatment alone (the control group) or conventional treatment combined with the experimental protocol (the HVHF&HP group) and were prospectively followed in our hospital. APACHE II score, SOFA score, ICU and hospital stay duration, and serum biomarkers were considered endpoints. RESULTS Ten HL-SAP patients accepted conventional treatment alone (the control group) and 10 patients underwent HVHF&HP combined with conventional treatment (the HVHF&HP group). The APACHE II score, SOFA score, systolic blood pressure, diastolic blood pressure, heart rate, serum amylase, and serum creatinine were significantly reduced after the HVHF&HP treatment. The changes in these variables were significantly different between the HVHF&HP and control group at 48 hours after the initiation of treatment. Patients in the HVHF&HP group had a significantly shorter ICU stay (P=.015). The reduction in serum triglyceride and cholesterol in the HVHF&HP group after 2, 6, 12, 24, and 48 hours was greater than the control group. All of the tested serum cytokines were significantly decreased after HVHF&HP treatment (P < .05). However, in patients who underwent conventional treatment alone, there was no significant change in the serum cytokines. CONCLUSION This study suggests that the addition of HVHF&HP to conventional treatment for HL-SAP patients may be superior to conventional treatment alone for the improvement of serum biomarkers and clinical outcomes.
Collapse
Affiliation(s)
- Shiren Sun
- Dr. Shiren Sun, Department of Nephrology,, Xijing Hospital,, The Fourth Military Medical University,, No. 127 Changle West Road,, Xi'an, Shhanxi 710032, China, T: +8602984775193, F: +8602984773494,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Galán Carrillo I, Demelo-Rodriguez P, Rodríguez Ferrero ML, Anaya F. Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia. J Clin Lipidol 2015; 9:698-702. [PMID: 26350817 DOI: 10.1016/j.jacl.2015.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/19/2015] [Accepted: 07/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Severe hypertriglyceridemia (HTG) leads to major complications such as acute pancreatitis. Lipoprotein apheresis has been proposed as a therapeutic tool for decreasing triglyceride levels, although experience is limited. OBJECTIVE To describe our experience with double filtration plasmapheresis (DFPP) in patients with severe HTG and pancreatitis in the plasmapheresis unit of a tertiary hospital in Spain. METHODS We recruited 4 patients with severe HTG (triglycerides [TGs] >1000 mg/dL) and acute pancreatitis. All the patients underwent DFPP as part of their treatment. Epidemiologic and laboratory data were collected before and after each plasmapheresis session. RESULTS The average TG level before plasmapheresis was 3136 mg/dL (35.44 mmol/L; range, 1306-6693 mg/dL, 14.76-75.63 mmol/L), and the average Acute Physiology And Chronic Health Evaluation (APACHE) II level before the first session was 6 (range, 3-8). All patients made a full recovery, with a significant improvement in TG levels after plasmapheresis. The mean number of sessions was 2.1 (range, 1-3), and mean TG level after plasmapheresis was 428 mg/dL (4.84 mmol/L; range, 169-515 mg/dL; 1.91-5.82 mmol/L). After the first session, the mean decrease in TG levels was 69.16% (2169 mg/dL, range, 945-5925 mg/dL; 24.51 mmol/L, range, 10.78-66.95 mmol/L), and after the last session, TG levels fell by 89.09% (2794 mg/dL, range, 945-6198 mg/dL; 31.57 mmol/L, range, 10.68-70.04 mmol/L). None of the patients developed complications related to plasmapheresis. CONCLUSIONS According to available evidence and our own experience, DFPP can be an effective and rapid treatment option in patients with severe HTG and complications. However, further research, including randomized controlled studies, is necessary.
Collapse
Affiliation(s)
| | - Pablo Demelo-Rodriguez
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Anaya
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|
31
|
Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. PRZEGLAD GASTROENTEROLOGICZNY 2015. [PMID: 25960810 DOI: 10.5114/pg.2014.45412.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented. AIM To present 12 cases of AP successfully treated by insulin administration. MATERIAL AND METHODS Three hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients' medical records were retrospectively evaluated in this study. RESULTS Serum triglyceride levels decreased to < 500 mg/dl within 2-3 days. No complications of treatment were seen and good clinical outcome was observed. CONCLUSIONS Our results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.
Collapse
|
32
|
Zeitler H, Balta Z, Klein B, Strassburg CP. Extracorporeal Treatment in Severe Hypertriglyceridemia-Induced Pancreatitis. Ther Apher Dial 2015; 19:405-10. [DOI: 10.1111/1744-9987.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Heike Zeitler
- Internal Medical Clinic I; Centre of Extracorporeal Therapy and Autoimmunity (CETA); University of Bonn; Bonn Germany
| | - Zeynep Balta
- Internal Medical Clinic I; Centre of Extracorporeal Therapy and Autoimmunity (CETA); University of Bonn; Bonn Germany
| | - Burkhard Klein
- Internal Medical Clinic I; Centre of Extracorporeal Therapy and Autoimmunity (CETA); University of Bonn; Bonn Germany
| | - Christian P. Strassburg
- Internal Medical Clinic I; Centre of Extracorporeal Therapy and Autoimmunity (CETA); University of Bonn; Bonn Germany
| |
Collapse
|
33
|
Gök F, Köker S, Kılıçaslan A, Sarkılar G, Yosunkaya A, Otelcioğlu Ş. Acute Pancreatitis Due to Hypertriglyceridaemia in Pregnancy. Turk J Anaesthesiol Reanim 2015; 43:116-8. [PMID: 27366478 DOI: 10.5152/tjar.2014.83435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/25/2014] [Indexed: 12/13/2022] Open
Abstract
Acute pancreatitis due to hypertriglyceridaemia during pregnancy is a rare but severe clinical condition that may cause fatal results for both the mother and the foetus. Acute pancreatitis developed in a 37-year-old pregnant woman with familial hypertriglyceridaemia and diabetes mellitus in the 31(st) week of pregnancy. As intrauterine foetal death developed, the pregnancy of the patient was terminated. Additionally, insulin, octreotide and plasmapheresis with "double membrane filtration" were applied, and triglycerides rapidly decreased. After 24 hours, the level of triglycerides decreased from 9742 mg dL(-1) to 432 mg dL(-1). The patient was discharged from the intensive care unit at the end of 5 days and was discharged from the hospital after 32 days. The current article presents the successful treatment of severe hypertriglyceridaemia in a pregnant case.
Collapse
Affiliation(s)
- Funda Gök
- Department of Anaesthiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Selçuk Köker
- Department of Anaesthiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Alper Kılıçaslan
- Department of Anaesthiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Gamze Sarkılar
- Department of Anaesthiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Alper Yosunkaya
- Department of Anaesthiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Şeref Otelcioğlu
- Department of Anaesthiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| |
Collapse
|
34
|
Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. GASTROENTEROLOGY REVIEW 2015; 10:18-22. [PMID: 25960810 PMCID: PMC4411402 DOI: 10.5114/pg.2014.45412] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/16/2014] [Accepted: 05/01/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Hypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented. AIM To present 12 cases of AP successfully treated by insulin administration. MATERIAL AND METHODS Three hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients' medical records were retrospectively evaluated in this study. RESULTS Serum triglyceride levels decreased to < 500 mg/dl within 2-3 days. No complications of treatment were seen and good clinical outcome was observed. CONCLUSIONS Our results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.
Collapse
|
35
|
Deng YY, Wang R, Wu H, Tang CW, Chen XZ. Etiology, clinical features and management of acute recurrent pancreatitis. J Dig Dis 2014; 15:570-7. [PMID: 25139414 DOI: 10.1111/1751-2980.12180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the etiology and clinical features of acute recurrent pancreatitis (ARP) and to determine its optimal management and outcomes. METHODS ARP cases among acute pancreatitis patients who were admitted to the West China Hospital, Sichuan University from January 2008 to December 2012 were retrospectively collected. Their etiology, clinical features, treatments and outcomes were analyzed. RESULTS Of all pancreatitis patients, 8.9% were classified as ARP. The proportions of mild and severe diseases were 85.7% and 14.3%, respectively. The common etiological factors were biliogenic (31.0%), alcohol (26.2%), hyperlipidemia (21.4%) and pancreaticobiliary malformation (15.4%). At first 46 cases were cryptogenic and among them 36 were subsequently confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Among the hyperlipidemic ARP patients, 72.2% failed to routinely monitor and control serum lipids. ERCP was performed in 88 cases, and 48 also required an endoscopic sphincterotomy or calculus removal. Twenty-two patients underwent cholangiopancreatic duct stent placement, and pancreatic necrosectomy was performed on eight severe cases. The overall outcomes indicate that 8.3% of the cases progressed to chronic pancreatitis and 33.3% of the cases receiving etiological treatment were recurrence-free. There were no deaths in this study. CONCLUSIONS The etiological factors of ARP are similar to those of acute pancreatitis at the first attack. The management of ARP should be fully considered based on etiological investigation.
Collapse
Affiliation(s)
- Yi Yun Deng
- Intensive Care Unit, Sichuan University, Chengdu, Sichuan Province, China
| | | | | | | | | |
Collapse
|
36
|
Markota A, Knehtl M, Sinkovic A, Ekart R, Hojs R, Bevc S. Plasma exchange treatment for acute hyperlipidemic pancreatitis with falsely low levels of serum triglycerides – a case report. Transfus Apher Sci 2014; 51:178-80. [DOI: 10.1016/j.transci.2014.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022]
|
37
|
Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014; 25:689-94. [PMID: 25269432 DOI: 10.1016/j.ejim.2014.08.008] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/21/2022]
Abstract
Severe hypertriglyceridemia (HTG) is a well established and the most common cause of acute pancreatitis (AP) after alcohol and gall stone disease. It is alleged to account for up to 10% of all pancreatitis episodes. Studies suggest that in patients with triglyceride (TG) levels>1000 mg/dL (>11.3 mmol/L), hypertriglyceridemia-induced acute pancreatitis (HTGP-AP) occurs in approximately 15-20% of all subjects referred to Lipid Clinics. Until now, there is no clear evidence which patients with severe HTG will develop pancreatitis and which will not. Underlying pathophysiological concepts include hydrolysis of TG by pancreatic lipase and excessive formation of free fatty acids with inflammatory changes and capillary injury. Additionally hyperviscosity and ischemia may play a decisive role. The clinical features of HTG-AP patients are supposed to be no different from patients with AP of other etiologies. Yet, there are well-conducted studies suggesting that HTG-AP is associated with a higher severity and complication rate. Therapeutic measurements in HTG-AP include dietary modifications, different antihyperlipidemic agents, insulin and/or heparin treatment. The beneficial use of plasmapheresis is repeatedly reported and suggested in many studies. Yet, due to the lack of randomized and controlled trials, it is currently unknown if plasmapheresis may improve morbidity and mortality in the clinical setting of HTG-AP. Since there are no commonly accepted clinical guidelines in the management of HTG-AP, there is a definite need for an international, multicenter approach to this important subject.
Collapse
Affiliation(s)
- Pedro Valdivielso
- Department of Medicine and Dermatology, University of Malaga, Spain; Servicio de Medicina Interna, Hospital Virgen de la Victoria, Malaga, Spain
| | - Alba Ramírez-Bueno
- Servicio de Medicina Interna, Hospital Virgen de la Victoria, Malaga, Spain
| | - Nils Ewald
- Justus-Liebig-University Giessen, 35392 Giessen, Germany; General Hospital Luebbecke-Rahden, Department of Internal Medicine, 32312 Luebbecke, Germany.
| |
Collapse
|
38
|
Hang Y, Chen Y, Lu LX, Zhu CQ. Acute hyperlipidemic pancreatitis in a pregnant woman. World J Emerg Med 2014; 4:311-3. [PMID: 25215139 DOI: 10.5847/wjem.j.issn.1920-8642.2013.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute pancreatitis is a serious complication during pregnancy, however the incidence of hyperlipidemia induced by pancreatitis is lower. METHODS We treated a pregnant woman with hypertriglyceridemia-associated acute gestational pancreatitis who simultaneously developed hypoxemic acute respiratory failure (ARF). RESULTS The woman was successfully treated through noninvasive positive pressure ventilation (NPPV), emergent caesarean delivery, drainage of chylous ascites, and peritoneal lavage. CONCLUSION The signs and symptoms of ARF were greatly improved in this patient after NPPV and conventional therapies. Early NPPV may be related to good prognosis of the disease.
Collapse
Affiliation(s)
- Ying Hang
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yi Chen
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Li-Xiong Lu
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Chang-Qing Zhu
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| |
Collapse
|
39
|
Abstract
BACKGROUND Acute pancreatitis is a serious complication during pregnancy, however the incidence of hyperlipidemia induced by pancreatitis is lower. METHODS We treated a pregnant woman with hypertriglyceridemia-associated acute gestational pancreatitis who simultaneously developed hypoxemic acute respiratory failure (ARF). RESULTS The woman was successfully treated through noninvasive positive pressure ventilation (NPPV), emergent caesarean delivery, drainage of chylous ascites, and peritoneal lavage. CONCLUSION The signs and symptoms of ARF were greatly improved in this patient after NPPV and conventional therapies. Early NPPV may be related to good prognosis of the disease.
Collapse
Affiliation(s)
- Ying Hang
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yi Chen
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Li-Xiong Lu
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Chang-Qing Zhu
- Emergency Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| |
Collapse
|
40
|
|
41
|
Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: an observational cohort study. PLoS One 2014; 9:e102748. [PMID: 25047332 PMCID: PMC4105439 DOI: 10.1371/journal.pone.0102748] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022] Open
Abstract
Objectives The optimal therapy for hypertriglyceridemic acute pancreatitis, especially the role of plasma exchange (PE), is not entirely clear. The aim of our large, single-center, observational, cohort study was to analyze the factors affecting outcome in hypertriglyceridemic pancreatitis treated with PE. Methods We included 111 episodes of hypertriglyceridemic pancreatitis treated with PE, which occurred in 103 different patients. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, triglycerides, delay to first PE, and PE treatment details were retrospectively obtained from the patients’ records. The main outcome measures were length of hospitalization and in-hospital mortality. Results The patients were 47±9 years old and the median APACHE II score at first PE was 4 (inter-quartile range (IQR) 2–7). There was a seasonal variation in the incidence of hypertriglyceridemic pancreatitis, and the recurrence rate was 1.6% per year. Triglycerides at presentation did not correlate with APACHE II or influence the outcome. The mean reduction in triglycerides during PE was 59% (from 44±31 to 18±15 mmol/l), which was twice the reduction observed during conservative treatment (27% daily). The median hospital stay was 16 days (IQR 10–24) and in-hospital mortality was 5%. The median delay to first PE was 35 hours (IQR 24–52), and there was no difference in mortality in the early and late PE groups (7% vs. 6%, p = 0.79). The group with citrate anticoagulation during PE had a significantly lower mortality than the group with heparin anticoagulation (1% vs. 11%, p = 0.04), and citrate was an independent predictor also in the multivariate model (p = 0.049). Conclusions PE effectively reduced serum triglycerides faster than could be expected with conservative treatment. The delay in PE therapy did not influence survival. We found that citrate anticoagulation during PE was associated with reduced mortality, which should be confirmed in a randomized study.
Collapse
|
42
|
Seda G, Meyer JM, Amundson DE, Daheshia M. Plasmapheresis in the management of severe hypertriglyceridemia. Crit Care Nurse 2014; 33:18-23; quiz 24. [PMID: 23908166 DOI: 10.4037/ccn2013346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Plasmapheresis can benefit a variety of critically ill patients. A woman with diabetic ketoacidosis and severe hypertriglyceridemia was treated with plasmapheresis when conventional treatments did not markedly reduce her triglyceridemia. The patient was admitted to a medical intensive care unit because of diabetic ketoacidosis with severe lipemia. The lipemia-associated interference in laboratory studies made treatment of electrolyte abnormalities extremely difficult. The hypertriglyceridemia was initially treated with insulin, antilipidemic medications, and heparin, but the levels of triglycerides remained elevated, delaying results of needed laboratory studies for hours. After plasmapheresis, the serum level of triglycerides decreased by 77% in less than 24 hours. Severe lipemia interferes with photometric laboratory studies, yielding an underestimation of serum levels of electrolytes. Plasmapheresis is safe, rapid, and effective for emergent management of severe hypertriglyceridemia in critically ill patients. The impact of the procedure on critical care nursing is growing as nurses become involved in the treatment and follow-up care of patients who have plasmapheresis.
Collapse
Affiliation(s)
- Gilbert Seda
- Medical Corps, US Navy, Department of Pulmonary and Critical Care Medicine, Naval Medical Center San Diego, San Diego, California, USA.
| | | | | | | |
Collapse
|
43
|
Hemodiafiltration Combined with Resin-Mediated Absorption as a Therapy for Hyperlipidemic Acute Pancreatitis. Cell Biochem Biophys 2014; 69:699-702. [DOI: 10.1007/s12013-014-9855-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
44
|
Bays HE, Tighe AP, Sadovsky R, Davidson MH. Prescription omega-3 fatty acids and their lipid effects: physiologic mechanisms of action and clinical implications. Expert Rev Cardiovasc Ther 2014; 6:391-409. [DOI: 10.1586/14779072.6.3.391] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
45
|
Madsen KR. Fatal hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine. BMJ Case Rep 2014; 2014:bcr-2013-202039. [PMID: 24403385 DOI: 10.1136/bcr-2013-202039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 27-year-old man treated with quetiapine for anxiety disorder developed hypertriglyceridaemia-induced acute pancreatitis and diabetic ketoacidosis. He was otherwise physically healthy with no family history of hyperlipidaemia. Despite aggressive intensive therapy he died of multiorgan failure within 36 h from initial presentation. While second-generation antipsychotics are well known to be causally linked to diabetes and hyperlipidaemia, this is to my knowledge the first-described case of a fatal triad of extreme hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine. Clinicians should be aware of this rare clinical presentation since rapid progression to multiorgan failure can occur. Early supportive therapy should be initiated. Lactescent serum and ketoacidosis in severe acute pancreatitis should not be overlooked-initiate insulin therapy and possibly plasmapheresis in case of extreme hypertriglyceridaemia.
Collapse
|
46
|
|
47
|
In vitro antioxidant and antihyperlipidemic activities of Toddalia asiatica (L) Lam. Leaves in Triton WR-1339 and high fat diet induced hyperlipidemic rats. Food Chem Toxicol 2013; 60:135-40. [DOI: 10.1016/j.fct.2013.07.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 06/09/2013] [Accepted: 07/12/2013] [Indexed: 11/20/2022]
|
48
|
Rajendran R, Abu E, Fadl A, Byrne CD. Late effects of childhood cancer treatment: severe hypertriglyceridaemia, central obesity, non alcoholic fatty liver disease and diabetes as complications of childhood total body irradiation. Diabet Med 2013; 30:e239-42. [PMID: 23692373 DOI: 10.1111/dme.12234] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Childhood cancer survivors may develop a number of endocrine complications linked to organ failure, such as hypogonadism, diabetes and growth hormone deficiency. However, increasing evidence now suggests that total body irradiation treatment, specifically, is linked with future risk of insulin resistance, hepatic steatosis and dyslipidaemia, possibly because total body irradiation affects adipocyte differentiation and impairs subcutaneous adipose tissue depot expansion during times of positive energy balance. CASE REPORT We describe a 20-year-old woman who developed pancreatitis with severe hypertriglyceridaemia (serum triglycerides > 300 mmol/l) that required plasmapheresis. She had received total body irradiation prior to her bone marrow transplant at age 6 years for relapsed acute lymphoblastic leukaemia. She developed ovarian failure at age 12 years. At age 15 years she was noted to have hyperglycaemia, increased blood pressure, hepatic steatosis and mild hypertriglyceridaemia. She presented with severe hypertriglyceridaemia and eruptive xanthoma, and developed pancreatitis 12 h after admission. She was treated with plasmapheresis and intravenous insulin and made an excellent recovery. We implicate and discuss total body irradiation as the major contributing factor to her severe hypertriglyceridaemia, compounded by worsening glycaemic control, oestrogen deficiency and a changing adult lifestyle. CONCLUSION Children who have received total body irradiation are at risk of diabetes and an exaggerated form of the metabolic syndrome with hypertriglyceridaemia, which can be life-threatening. We suggest that survivors of total body irradiation treatment require careful lifelong monitoring of their metabolic status.
Collapse
Affiliation(s)
- R Rajendran
- Department of Diabetes and Endocrinology, Southampton General Hospital, University Hospitals of Southampton NHS Foundation Trust, Southampton, UK.
| | | | | | | |
Collapse
|
49
|
Senosiain Lalastra C, Tavío Hernández E, Moreira Vicente V, Maroto Castellanos M, García Sánchez MC, Aicart Ramos M, Téllez Vivajos L, Cuño Roldán JL. Pancreatitis aguda por hipertrigliceridemia. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:274-9. [DOI: 10.1016/j.gastrohep.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 11/16/2012] [Indexed: 01/28/2023]
|
50
|
Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial 2013; 17:130-7. [PMID: 23551669 DOI: 10.1111/1744-9987.12008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available. Standard therapeutic measures are based on the use of lipid-lowering agents (fenofibrate, gemfibrozil, niacin, Ω-3 fatty acids), low molecular weight heparin, and insulin in diabetic patients. However, when standard medical therapies have failed, non-pharmacological approaches based upon the removal of triglycerides with therapeutic plasma exchange can also provide benefit to patients with severe hypertriglyceridemia and acute pancreatitis. Plasma exchange could be very helpful in reducing triglycerides levels during the acute phase of hyperlipidemic pancreatitis, and in the prevention of recurrence. The current evidence on management of acute pancreatitis and severe hypertriglyceridemia, focusing on symptoms, treatment and potential complications is reviewed herein.
Collapse
Affiliation(s)
- Claudia Stefanutti
- Department of Immunohematology and Transfusion Medicine,, Extracorporeal Therapeutic Techniques Unit, Rome, Italy.
| | | | | |
Collapse
|