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Guarino AL, Cagle LA, Ehrhardt CM, Beatty SSK, Stern JK, Gilor C, Specht AJ, Londoño LA. Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog. J Vet Emerg Crit Care (San Antonio) 2023; 33:247-256. [PMID: 36573353 DOI: 10.1111/vec.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog. CASE SUMMARY A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus. NEW OR UNIQUE INFORMATION PROVIDED This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided.
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Affiliation(s)
- Aria L Guarino
- Blue Pearl Veterinary Partners, Rockville, Maryland, USA
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Laura A Cagle
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Caryn M Ehrhardt
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Sarah S K Beatty
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Antech Diagnostics, Fountain Valley, California, USA
| | - Jere K Stern
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Auburn University Clinical Pathology Laboratory, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Chen Gilor
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Andrew J Specht
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Leo A Londoño
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Capital Veterinary Specialists, Jacksonville, Florida, USA
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Zheng CB, Zheng ZH, Zheng YP. Therapeutic plasma exchange for hyperlipidemic pancreatitis: Current evidence and unmet needs. World J Clin Cases 2021; 9:5794-5803. [PMID: 34368298 PMCID: PMC8316951 DOI: 10.12998/wjcc.v9.i21.5794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
With changes in lifestyle and diet worldwide, the prevalence of hyperlipidemic acute pancreatitis (HLAP) has greatly increased, and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol. There are many available therapies for HLAP, including oral lipid-lowering agents, intravenous insulin, heparin, and therapeutic plasmapheresis (TPE). It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides (TG), thus a rapid decrease in serum TG level is the key to the successful management of HLAP. TPE has emerged as an effective modality in rapidly reducing serum TG levels. However, due to its cost and accessibility, TPE remains poorly evaluated until now. Some studies revealed its efficacy in helping to treat and prevent the recurrence, while some studies suggested that TG levels were not correlated with disease severity, mortality, or length of hospital stay. Thus TPE might have no beneficial effect for the outcome. This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors, adverse effects of the procedure, and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis. Future direction of TPE research for HLAP is also discussed in this review.
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Affiliation(s)
- Can-Bin Zheng
- Department of Endocrine and Metabolic Disease, Shantou Central Hospital, Shantou 515031, Guangdong Province, China
| | - Zi-Hui Zheng
- Nursing College, Guangdong Pharmaceutical University, Guangzhou 510000, Guangdong Province, China
| | - Yong-Ping Zheng
- Department of Gastroenterology, Shantou Central Hospital, Shantou 515031, Guangdong Province, China
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