Insulin and heparin in treatment of hypertriglyceridemia-induced pancreatitis

Abstract

We read with great interest the case report, “Hypertriglyceridemia -induced pancreatitis: A case-based review” by Gan et al in the November 2006 issue of World Journal of Gastroenterology. We agree that in acute setting, pancreatitis due to hypertriglyceridemia (HTG) should be ruled out as it is a treatable and preventable condition. It needs to be treated conservatively along with measures to lower the triglyceride level. The various modalities to treat hypertriglyceridemia are plasmapheresis, insulin and heparin, purified apo C II, and fibric acid derivatives. Plasmapheresis and purified apo C II infusion are not easily available. There is limited literature about the efficacy of intravenous insulin and heparin, both of which can enhance lipoprotein lipase activity. We treated two patients with hypertriglyceridemiainduced pancreatitis with insulin and heparin. The details of the two patients are given in Table 1. Both of the patients had recurrent acute pancreatitis, one of them was a diabetic patient. Other etiologies such as gallstones, alcohol, drugs, hypercalcemia and trauma were ruled out. Investigations revealed lipemic serum in both patients. The liver function tests and calcium were normal. The serum triglycerides were more than 1000 mg/dL in both the patients at admission. The chest roentgenogram and fundus examination were normal. Both of the patients were treated with regular insulin in 5% dextrose infusion to maintain blood sugar levels between 150-200 mg/dL, and 5000 U heparin subcutaneously twice a day to lower the triglyceride level in addition to conservative PO Box 2345, Beijing 100023, China World J Gastroenterol 2007 May 14; 13(18): 2642-2643 www.wjgnet.com World Journal of Gastroenterology ISSN 1007-9327 wjg@wjgnet.com © 2007 The WJG Press. All rights reserved.