7682 Triglyceride Tango: when Triglycerides take legs for a spin

Abstract

Abstract Disclosure: D. Misra: None. M.R. Brennan: None. L. Misra: None. M. Kiryakoza: None. A 33-year-old male with no significant medical history presented with acute abdominal pain and n/v. The patient stated his RLQ pain extended down his R. leg resulting in weakness. He was on no medications at home. Vitals signs were stable, and the physical exam revealed diffuse abdominal tenderness in the RLQ and R. flank area with guarding, but no rebound and Neuro exam showed 4/5 strength in the RLE, the rest of the neuro exam was non-focal. Labs revealed an elevated lipase > than 3 times the upper limit and an elevation in transaminases. Other labs including blood glucose and white blood cell count were normal. CT was also performed and revealed significant inflammatory stranding of the pancreatic head and neck along the duodenum. The working diagnosis was pancreatitis. IV fluids were started, and the patient received IV Dilaudid for pain. There was no improvement in his symptoms overnight, so an abdominal CT was repeated. Imaging showed an interval development of a phlegmon and free fluid along the right paracolic gutter extending to the porta hepatis. The patient’s lipid panel revealed a triglyceride level of >1420 mg/dl. Endocrine was consulted and recommended initiation of a fenofibrate and atorvastatin. Although the patient was not a diabetic, endocrinology gave 20 units of basal insulin to the patient (Lantus). Within 24 hours of initiating basal insulin, the triglycerides fell to 680 mg/dl and the patient’s symptoms resolved. The patient was discharged home on day #3 on fenofibrate 160 mg/day and atorvastatin 40 mg/day. The patient was told to follow up with PCP for dyslipidemia and additional work up for transient right sided weakness. The two commonest causes of pancreatitis are alcohol and gallbladder disease, but it is important to entertain other causes. A lipid panel was drawn due to both pancreatitis and the right sided weakness, both of which resolved with the lowering of triglycerides. It is uncertain if hypertriglyceridemia is directly attributed to the right sided weakness, although neurologic findings due to hyperviscosity syndrome in hypertriglyceridemia have been described. If a causal relationship can be established, additional therapy such as anti-platelet therapy should be considered. This case also demonstrates that severe hypertriglyceridemia can be controlled with oral medications and subcutaneous insulin, even in non-diabetics, as opposed to IV insulin which could shorten hospital stays and decrease medical costs. Presentation: 6/3/2024