SAT-568 Hypertriglyceridemia-Induced Pancreatitis in a Pregnant Female Treated with Plasmapheresis

Abstract

Hypertriglyceridemia-Induced Pancreatitis in a Pregnant Female Treated with PlasmapheresisBackground: Gestational hypertriglyceridemia can lead to critical and even life-threatening consequences to both mother and fetus. A well-known consequence is hypertriglyceridemia-induced acute pancreatitis. Few case reports described the successful management of triglyceride (TG) induced pancreatitis in pregnant women using plasmapheresis.Clinical Case:A 28-year-old primigravida patient, in the 29th week of gestation, was admitted with acute onset of epigastric pain and nausea for 24 hours. Laboratory findings were remarkable for an elevated serum lipase of 505 U/L (ref 23–300) and an abnormal lipid profile. Her total cholesterol was 1651 mg/dl and triglycerides (TG) from an undiluted sample was 1361 mg/dl. When a 1:5 dilution was performed the result was higher at >4000 mg/dl. She was transferred to the ICU for treatment of acute pancreatitis. She has no family history of hypertriglyceridemia. No MRI was obtained. Gemfibrozil, Lovaza™ (omega-3-acid ethyl esters), and an insulin infusion were started but serum TG levels did not improve. On hospital day 2 she developed worsening tachycardia, tachypnea with laboratory findings of metabolic acidosis and hypocalcemia. As there was no reduction in triglyceride levels with medical therapy and her clinical status was deteriorating, the treating multidisciplinary team decided to initiate plasmapheresis. After one session, TG levels decreased from >4000 mg/dl to 1829 mg/dl and continued to decline to 721 mg/dl. Hospital day 6 her TG level rose to 1245 mg/dl prompting a second plasmapheresis. TG levels decreased to 770 mg/dl shortly after but rose the next day to 1365 mg/dl. She underwent a 3rd plasmapheresis after which her TG ranged from 400–700 mg/dl for the remainder of her hospitalization. On the day of discharge, her TG level was 733 mg/dl. She was advised to restrict fat intake and continue both gemfibrozil and Lovaza™ but despite this her TGs again increased to 1693 mg/dl. From that point she started weekly sessions of plasmapheresis for a total of 8 sessions prior to an uneventful vaginal delivery at 36 weeks of gestation. One month later her lipid profile dramatically improved. Total cholesterol was 233 mg/dl and triglycerides were 304 mg/dl while on lipid lowering therapy.Conclusion: Pancreatitis during pregnancy is associated with a high maternal and fetal death rate. Early treatment is important for the survival of the mother and fetus. Plasmapheresis is an alternative and safe treatment for cases that are not responsive to medical therapy. It can be administered safely to reduce triglyceride levels and diminish the systemic inflammatory response leading to a shortened hospital stay and better outcomes.