Poster Abstract Abstract
(Severe Hypertriglyceridemia), #220515446312
Severe Hypertriglyceridemia successfully treated with insulin infusion: A Case Report
Rabeah Md zuki, Hospital Pulau Pinang; Shanty Velaiutham, Hospital Pulau Pinang; Khaw Chong Hui, Hospital Pulau Pinang; Sun Choon Peng, Hospital Pulau Pinang
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Patients with severe hypertriglyceridemia (HT) is at risk of developing life-threatening acute pancreatitis and cardiovascular disease. There is no standard guideline on managing severe HT in acute setting. Apheresis, heparin and insulin therapy has been utilised and reported.
We report a 42 years old man who was referred to us from private healthcare for severe HT. He has underlying hypertension and dyslipidaemia diagnosed since 1 year ago. He was prescribed with atorvastatin and fenofibrate for his lipid management. He was only recently diagnosed with Diabetes Mellitus(DM) with HbA1c of 13%. There was no family history of hyperlipidemia or ischaemic heart disease. He did not any abdominal pain or chest pain. On examination, there was multiple eruptive xanthomata over his bilateral elbow and knee at the extensor area and also achilles tendon area.
Blood investigation revealed severe HT with serum triglyceride(TG) of 44.6mmol/L and total cholesterol of 19.6mmol/L. His blood exhibited thick and milky supernatant. Serum amylase was not elevated. Liver function test was normal. In view of severe HT, we admitted him to the ward and variable rate insulin infusion was started. His TG decreased progressively to 22.7mmol/L by day 2 of admission and finally to 10.7mmol/L by day 6 of admission. He was discharged with statin and fenofibrate together with his antihyperglycaemic medications. Screening for his family member also done. Although there was no family history, we planned for genetic study for him soon.
This case showed successful therapy for severe HT with insulin infusion. Insulin infusion is effective, non-invasive and cost-effective for treatment of severe HT. Rapid reduction of high TG is important to reduce risk of pancreatitis.