Management of Very Severe Hypertriglyceridemia With and Without Plasma Exchange

Abstract

Acute pancreatitis (AP) is a potentially life-threatening complication of severe hypertriglyceridemia (HTG). The risk of AP markedly increases with triglyceride (TG) levels > 22.6 mmol/L (normal < 1.7 mmol/L), but can be prevented by maintaining TG < 11.3 mmol/L. Usual management of HTG-induced AP includes cessation of oral intake, fluid replacement, and correction of secondary factors that predispose to HTG. Plasma TG levels typically fall with these conservative measures. Recently, several anecdotal reports of plasma exchange (PLEx) in the early stages of HTG-induced AP have demonstrated dramatic TG reductions in acute setting.