EFFICACY AND SAFETY OF IV INSULIN INFUSION FOR MANAGEMENT OF HYPERTRIGLYCERIDEMIC PANCREATITIS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hypertriglyceridemic pancreatitis (HTGP) portends significant morbidity and mortality, and management involves rapid lowering of serum triglycerides (TG). Both plasmapheresis (PL) and intravenous (IV) insulin infusions are effective for this purpose, although comparative analyses of these interventions have not been performed. Furthermore, the role of IV insulin in patients with HTGP without diabetes remains unknown. We aimed to investigate these questions in a cohort of patients hospitalized for HTGP at a tertiary care center. METHODS: A retrospective chart review of patients hospitalized for acute HTGP between January 1, 2001 and December 31, 2018 was performed. Patients were stratified according to treatment modality: IV insulin infusion, PL+/- IV insulin, or conservative management. Efficacy of TG-lowering and clinical outcomes were compared between groups. RESULTS: One hundred and four patients with HTGP were identified. Seventy-eight patients (75 %) were treated with IV insulin, 6 (5.8%) were treated with PL, and 20 (19.2%) received conservative management. Admission TG levels were significantly higher in the IV insulin and PL vs. conservative group (p = 0.009). The percent decline in TG levels from admission to hospital discharge was 80.8% ±13.2%, 90.0% ± 5.6%, 63.9% ± 30.5% among the IV insulin, PL, and conservative groups, respectively (p=0.0214), with no statistically significant differences seen between IV insulin and PL groups. Eighty (80.0%) patients had diabetes mellitus, the majority of whom received IV insulin (81.3%). Among patients without diabetes, 54.2% received IV insulin only. Hospital complications, hypoglycemic events, and LOS did not differ between patients with and without diabetes who received IV insulin. CONCLUSIONS: Intravenous insulin infusion is a safe and effective method for reducing serum triglyceride levels in both diabetic and non-diabetic patients diagnosed with acute HTGP. CLINICAL IMPLICATIONS: IV insulin infusion is effective and safe for management of acute HTPG when compared to conservative management or plasmapheresis. Given the challenges associated with use of plasmapheresis and its limited clinical utility, IV insulin infusion should be considered as a first line therapy for treatment of this entity in both diabetic and non-diabetic individuals. DISCLOSURES: No relevant relationships by Hasan Ahmad Hasan Albitar, source=Web Response No relevant relationships by Adham Alkurashi, source=Web Response No relevant relationships by Yahya Almodallal, source=Web Response no disclosure on file for Tiffany Cortes; No relevant relationships by Kristen Gonzales, source=Web Response No relevant relationships by Sumedh Hoskote, source=Web Response No relevant relationships by Maria Hurtado, source=Web Response No relevant relationships by vivek iyer, source=Web Response no disclosure on file for Prashant Jagtap; No relevant relationships by Vinaya Simha, source=Web Response