Extreme hypertriglyceridemia managed with intravenous insulin with or without nil per oral: is there a difference?

Malabu, Usman H., Thuzar, Moe, Shenoy, Vasant V., Schrale, Ryan, and Sangla, Kunwarjit Singh (2014) Extreme hypertriglyceridemia managed with intravenous insulin with or without nil per oral: is there a difference? In: Abstracts from the 16th International Congress of Endocrinology. From: ICE/ENDO 2014: 16th International Congress of Endocrinology, June 20-24 2014, Chicago, IL, USA.

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Extreme hypertriglyceridemia defined as serum triglyceride (TG) level >50 mmol/l (4425 mg/dl) can lead to acute pancreatitis (1). Rapid lowering of plasma TG is necessary in order to prevent such life threatening complications. However, there is no established guideline on the acute/immediate management of severe hypertriglyceridemia in clinical practice (2). The aim of the study was to review acute management and clinical course of patients with extremely high serum TG at a regional hospital. Ten cases of extreme hypertriglyceridemia admitted at the Australia's Townsville Hospital between January 2010 and October 2013 were retrospectively reviewed. Age range: 24-55 years. Nine out of the 10 subjects were patients with type 2 diabetes, 3 of them were newly diagnosed. Mean haemoglobin A1C was 12% (108 mmol/mol) and mean random blood glucose at presentation was 324 mg/dl (range: 184-533). Five patients presented with acute pancreatitis. Mean TG at presentation was 100.5 mmol/l (8894 mg/dl). Plasma TG levels decreased by about 80% in the first 24 hours in those patients who were managed with nil per oral (NPO) and intravenous (IV) insulin infusion (n=4) and by about 40% in those treated with IV insulin infusion alone without NPO (n=4). Furthermore, mean daily serum TG was lower in subjects on insulin + NPO compared to patients on insulin alone 9.5 vs 33.8 mmol/l (841 vs 2991 mg/dl), p=0.0002; CI: 13.0-38.3. The clinical course was uncomplicated in all except one patient who subsequently developed a pancreatic pseudocyst. Thus, poorly controlled type 2 diabetes is a common trigger for extreme hypertriglyceridemia. Combination of NPO and IV insulin is an effective, simple and safe treatment strategy in immediate management of severe hypertriglyceridemia. Further prospective studies on a larger population are needed to confirm our findings.

Item ID: 33854
Item Type: Conference Item (Abstract / Summary)
Funders: James Cook University (JCU)
Date Deposited: 24 Sep 2014 00:19
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110306 Endocrinology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 100%
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