OR24-03 Triglyceride Clearance In Hypertriglyceridemic Pancreatitis: Time-course And Implications For Management

Abstract

Abstract Disclosure: S.K. Majumdar: None. Introduction: Uncertainty exists for how to optimally manage severely elevated triglyceride (Tg) levels in patients with hypertriglyceridemic (HTg) pancreatitis. Standard recommendations include NPO (nil per os) status and intravenous (iv) insulin for most patients, yet information is lacking in regards to the natural time-course of Tg lowering, the degree of benefit insulin provides and for whom it may be indicated, and for the Tg level at which transition to feeding would be appropriate. Underlying Questions: (1) What is the natural time-course of triglyceride (Tg) lowering when nutritional intake is held and (2) does it differ according to etiology of hypertriglyceridemia? (3) What is the role of intravenous insulin in acute Tg lowering, and (4) at what threshold of Tg can nutritional intake safely resume? Methods: A retrospective study of patients hospitalized from October 2013 through December of 2018 with a diagnosis of pancreatitis associated with hypertriglyceridemia Tg ≥ 5.65 mM (500 mg/dL), in absence of other causes, was performed by medical record review. The time-course of Tg lowering was assessed for differences in relation to initial Tg values, use of iv insulin, ethanol vs. non ethanol associated causes, and time to Tg values of < 5.65 mM (500 mg/dL) vs < 11.29 (1000 mg/dL). Results: Sixty-six cases were identified and 45 had multiple measurements for time-course evaluation. Those with initial Tg values < 45.16 mM (4000 mg/dL) achieved Tg levels < 11.29 mM in < 3 days, while 18.8% with higher values took 5-9 days. Insulin therapy was associated with a longer duration, and ethanol with a shorter duration, of hypertriglyceridemia. Tg clearance in ethanol associated hypertriglyceridemia appeared independent of insulin treatment. Time to Tg < 5.65 mM vs < 11.29 mM was significantly longer when initial Tg levels were > 22.58 mM (2000 mg/dL). Conclusion: An arbitrary threshold of 45.16 mM (4000 mg/dL) for initial Tg’s in HTg pancreatitis appears to separate those likely to achieve Tg’s < 11.29 mM in < 3 vs. > 3 days, independent of cause or treatment in absence of known genetic defects in Tg clearance. Insulin therapy remains appropriate for hyperglycemic patients but appears unnecessary for isolated ethanol associated hypertriglyceridemia. A threshold Tg of <11.29 mM appears more practical than <5.65 mM for resuming nutritional intake. A randomized trial is necessary to confirm these findings. Presentation: Saturday, June 17, 2023