3198 An Unusual Case of Severe Hypertriglyceridemia in an Alcohol Naïve Patient

Abstract

INTRODUCTION: Hypertriglyceridemia (HT) is a metabolic disorder due to an altered synthesis of lipoproteins. Although HT is often asymptomatic, acute cases can result in pancreatitis and chronic elevations of HT can lead to the development of atherosclerotic disease. HT is most commonly caused by obesity, diabetes mellitus and excess alcohol intake. Alcohol-induced HT is due to increased very-low-density lipoprotein secretion and impaired lipolysis. Previous research has shown an association of severe HT with chronic alcohol use. Here, we present an unusual case of new onset severe HT in a patient who recently began drinking alcohol. CASE DESCRIPTION/METHODS: A 42 year old female with a history of anxiety presented to the hospital with a primary complaint of suicidal ideation. Patient was subsequently admitted to psychiatric inpatient ward and medical team was consulted after labs revealed triglyceride level of 3930. Patient was questioned about recent travel, recent drug use, and recent medication use and patient's answers were noted to be unremarkable for any concerning history in relation to her HT. She does admit to moderate alcohol use for the first time as an adult during the last week and her alcohol level on admission was slightly elevated at 45. Patient's vitals were reviewed and noted to be within normal limits and patient's laboratory values were also noted to be within normal limits including her CBC, CMP, urine drug screen and chest x-ray. Additionally, triglyceride levels obtained on prior visits have ranged from the 40's to the 120's with the most recent level one year prior to current admission being 47. CT abdomen and pelvis showed no signs of acute intra abdominal pathology. At time of exam, patient was resting comfortably in bed and her only complaint was anxiety. Patient's triglyceride level returned to normal during hospital stay after treatment with insulin and gemfibrozil. DISCUSSION: One of the most common causes of HT in the United States is alcohol abuse. More specifically, previous research has shown severe HT developing as a consequence of chronic alcohol use. This case highlights severe HT in a patient who is alcohol naïve and had previous normal triglyceride values. Additionally, her moderate consumption of alcohol during the previous week would not explain such high values of triglycerides. More research is needed to clearly identify the risk of severe HT in a patient who has limited history in drinking alcohol.