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Clinical Case Study

Hypertriglyceridemia induced acute pancreatitis managed with low

dose intravenous Insulin.

Sadalla Abdulhak Amer 1* , El-Rishi Mohammed Ali 2 .

1: Department of internal medicine Al Emadi

Hospital Doha Qatar

Introduction

2: Department of endocrinology Al Ahly

Hospital Doha Qatar

* Corresponding author

Hypertriglyceridemia (HTG) is the third most common cause of Acute Pancreatitis

Correspondence to:

Abdulhakamer1966@gmail.com

(AP). The mechanism of hypertriglyceridemia-induced pancreatitis is postulated to

Publication Data:

involve hydrolysis of triglycerides (TG) by pancreatic Lipase and release of free fatty

Submitted: January 3,2020

Accepted: February 14,2020

acids that induce free radical damage.

Online: March 15,2020

Insulin acts by activating lipoprotein lipase (LPL) which is a hydrolytic enzyme that

This article was subject to full peer-review.

enhance removal of TG from plasma. Insulin can be used to treat HTG in diabetic

and non-diabetic patients; it is competitive to other modalities as plasmapheresis in

cost and availability. Infusion of Insulin is likely to be more effective than using

subcutaneous route. The appropriate dose and duration of insulin in this context

need to be further elucidated [1].

Observation

A 35-years old non-diabetic male presented with upper abdominal pain and vomiting for

the past three days. He is known to have previous HTG induced AP five years ago.

Examination of abdomen elicits epigastric tenderness, pulse rate 105 bpm, blood

pressure 127/66 and temperature 37.2C. Pancreatic enzymes at presentation: Amylase

739 U/L (50-150 U/L), Lipase 1289 U/L (10-140 U/L) and TG 1208 mg/dl (40-170

mg/dl). Serum Creatinin is 0.98 mg/dl (0.6-1.3mg/dl), ALT 21 IU/L (8-32 IU/L), CRP 1.46

mg/dl (< 6 mg/dl). The electrocardiogram was normal. Explanation was given to the

patient that use of Insulin for HTG induced AP is not included in the local guideline but

well recognized treatment option; his HTG induced AP was managed with low dose

soluble insulin infusion in a dose of (0.5U/h) along with intravenous fluid, antibiotic,

analgesia and he was kept nil per mouth. A total of 10 U of Actrapid _® insulin was

infused over 20 hours daily for two days then Fenofibrate was reinstituted when he

started oral intake. The patient was closely monitored for glucose level hourly as well as

for potassium and magnesium. There was substantial reduction in TG level from 1208

down to 646 mg/dl after 12 hours and to 218 mg/dl after 36 hours, normalization of

pancreatic enzymes after 48 hours (Amylase 82 IU/L, Lipase77 IU/L). The patient

discharged after 3 days after favorable evolution .

Discussion

Acute Pancreatitis caused by HTG is likely to be more severe with higher rate of

complications compared to other etiologies [2,3] Therefore; rapid lowering of HTG

is a priority as it improves outcome of AP [4]. Insulin emerges as safe and effective

agent in lowering Triglyceride level within few days.

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The dose of insulin is widely variable among different studies, ranging from as low

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Non-Commercial License 4.0 (CCBY-NC) allowing

as 0.1-0.3 U/kg/h to higher doses of 6-10U/kg/h, which are usually needed in

sharing and adapting.

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diabetic patients [5,6]. The duration of Insulin therapy is another variable among

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reported cases; it ranges between 2-4 days. In non-diabetic patients lower doses of

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the work provided must be properly cited and

Insulin are usually used [7]. Although we used the lowest reported dose ; however,

cannot be used for commercial purpose.

it was safe and effective to lower hypertriglyceridemia within two days.

Citation : Sadalla AA, El-Rishi MA. Hypertriglyceridemia induced acute pancreatitis managed with low dose intravenous Insulin: A case

study.Jr.med.res.2020;3(1): 23-24. Sadalla et al © All rights are reserved. https://doi.org/10.32512/jmr.3.1.2020/23.24

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