Hypertriglyceridaemia as a cause of acute pancreatitis

Acute pancreatitis is an inflammatory disease of the pancreas associated with varying degrees of autodigestion, oedema, necrosis, and haemorrhage of the pancreatic tissue. Hypertriglyceridaemia is considered to be the third most common cause of acute pancreatitis, and a serum level > 1000 mg/dl has been strongly associated with acute pancreatitis.
A 39-year-old man with body mass index (BMI) 28 kg/m², without a past medical history, was admitted to hospital in good general condition, with epigastric pain, nausea and vomiting for 2 days, after alcohol drinking. His physical examination was notable for guarding and tenderness in the epigastric region – on the Trapnell scale – 2nd degree, arterial pressure within normal limits, regular heart rate – 98/minute. His initial diagnostics workup is summarised in Table 1 – noteworthy is the significantly elevated triglyceride level > 8000 with inability to calculate low-density lipoprotein (LDL) cholesterol fraction.
Abdominal computed tomography showed diffuse inflammatory stranding around the pancreas concerning the pancreatitis with no evidence of gallstones or biliary sludge. He denied any history of gallstones, pancreatitis, new medications, or recent abdominal procedures. Hospitalisation was complicated by exudate in both pleural cavities with the need for their drainage. He was treated with high-volume intravenous fluids, intravenous insulin regimen, heparin drip, pain control, lipid-lowering therapy with a statin and fibrate, carbapenem antibiotics, and nutritional treatment. The patient’s pain was well controlled, triglyceride levels decreased gradually, and the patient was discharged in stable condition with his home medications along with the addition of long-term statin and fibrate therapy and therapy to reduce insulin resistance.
Hypertriglyceridaemia is the third leading cause of acute pancreatitis after gallstones and alcohol abuse. The incidence of acute pancreatitis in patients with hypertriglyceridaemia is estimated at 5–77% by various authors. The pancreas plays an important role in lipid homeostasis, although the pancreas prefers lipids as a metabolic substrate. Acute pancreatitis produced experimentally in animals results regularly in the transient elevation of serum lipids for 1 to 4 days. However, investigations of others authors indicate that abnormalities in lipid metabolism are constant [1].
It is still unknown if hypertriglyceridaemia is the cause or...


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