219: EVALUATION OF HIGH-DOSE INSULIN FOR THE TREATMENT OF HYPERTRIGLYCERIDEMIC PANCREATITIS

Abstract

Introduction: Acute pancreatitis is a common inflammatory condition with several underlying etiologies, including hypertriglyceridemia induced. The risk for acute pancreatitis increases when the serum triglyceride levels exceeds more than 1000 mg/dL. Insulin therapy is a feasible therapeutic option to help lower triglyceride levels to minimize the complications of acute pancreatitis. The aim of this medication use evaluation is to characterize the use of high-intensity insulin to assess its use in hypertriglyceridemia induced acute pancreatitis. Methods: A single-center, retrospective, observational study at a large academic medical center will be conducted. All patients admitted to the medical intensive care unit from September 1st, 2018 to September 30th, 2021 who received high-dose insulin drip for hypertriglyceridemia-induced acute pancreatitis will be eligible for inclusion. The primary objective of this study is to assess the efficacy of using high-dose insulin drip for the treatment of hypertriglyceridemic pancreatitis with a secondary objective to evaluate the safety of high-dose insulin in this setting. Results: Only 27 patients met inclusion criteria. Twenty patients reached a triglyceride goal of less than 500 with only 9 patients experiencing hypoglycemic episodes. Each patient evaluated in this study had some reduction of their triglycerides after starting an insulin infusion. Seven patients received insulin plus plasmapheresis episodes. The average duration of insulin infusion was 70 hours with an average total insulin use of 435 units. Conclusions: All patients who received high-dose insulin infusion for hypertriglyceridemia-induced acute pancreatitis had reduction in their triglyceride levels after starting insulin infusion with 74% of patients reaching a goal triglyceride level less than 500. Only 7 patients evaluated in this study received insulin infusion plus plasmapheresis episode and the duration, total average units, and average units/hr of insulin were lower in the insulin plus plasmapheresis group compared to insulin alone group, however, no comparable data available in the literature at this time. Future studies comparing insulin and insulin in addition to plasmapheresis are needed to further analyze optimal treatment for hypertriglyceridemia induced pancreatitis.