Hypertriglyceridemia-induced Acute Pancreatitis Research Articles

Role of therapeutic plasma exchange in treatment of the hypertriglyceridemia-induced acute pancreatitis: Case report and literature review

Abstract: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is associated with a more severe clinical course than acute pancreatitis due to other etiologies. Presently, these patients are managed with dietary restrictions, analgesia, lipid-lowering agents, insulin/heparin dual therapy, and supportive care to prevent organ failure. Apart from these conventional therapies, therapeutic plasma exchange (TPE) is another potential treatment that is being performed as it results in rapid reduction in serum triglycerides and inflammatory cytokines, thus, leading to drastic improvements in clinical and laboratory findings and patient outcomes. Here, we report our experience of using TPE for HTG-AP in our patients.

Significant but partial lipoprotein lipase functional loss caused by a novel occurrence of rare LPL biallelic variants

BackgroundLipoprotein lipase (LPL) plays a crucial role in triglyceride hydrolysis. Rare biallelic variants in the LPL gene leading to complete or near-complete loss of function cause autosomal recessive familial chylomicronemia syndrome. However, rare biallelic LPL variants resulting in significant but partial loss of function are rarely documented. This study reports a novel occurrence of such rare biallelic LPL variants in a Chinese patient with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) during pregnancy and provides an in-depth functional characterization.MethodsThe complete coding sequences and adjacent intronic regions of the LPL, APOC2, APOA5, LMF1, and GPIHBP1 genes were analyzed by Sanger sequencing. The aim was to identify rare variants, including nonsense, frameshift, missense, small in-frame deletions or insertions, and canonical splice site mutations. The functional impact of identified LPL missense variants on protein expression, secretion, and activity was assessed in HEK293T cells through single and co-transfection experiments, with and without heparin treatment.ResultsTwo rare LPL missense variants were identified in the patient: the previously reported c.809G > A (p.Arg270His) and a novel c.331G > C (p.Val111Leu). Genetic testing confirmed these variants were inherited biallelically. Functional analysis showed that the p.Arg270His variant resulted in a near-complete loss of LPL function due to effects on protein synthesis/stability, secretion, and enzymatic activity. In contrast, the p.Val111Leu variant retained approximately 32.3% of wild-type activity, without impacting protein synthesis, stability, or secretion. Co-transfection experiments indicated a combined activity level of 20.7%, suggesting no dominant negative interaction between the variants. The patient’s post-heparin plasma LPL activity was about 35% of control levels.ConclusionsThis study presents a novel case of partial but significant loss-of-function biallelic LPL variants in a patient with HTG-AP during pregnancy. Our findings enhance the understanding of the nuanced relationship between LPL genotypes and clinical phenotypes, highlighting the importance of residual LPL function in disease manifestation and severity. Additionally, our study underscores the challenges in classifying partial loss-of-function variants in classical Mendelian disease genes according to the American College of Medical Genetics and Genomics (ACMG)’s variant classification guidelines.

Recent Treatment Strategies for Acute Pancreatitis.

Acute pancreatitis (AP) is a leading gastrointestinal disease that causes hospitalization. Initial management in the first 72 h after the diagnosis of AP is pivotal, which can influence the clinical outcomes of the disease. Initial management, including assessment of disease severity, fluid resuscitation, pain control, nutritional support, antibiotic use, and endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis, plays a fundamental role in AP treatment. Recent updates for fluid resuscitation, including treatment goals, the type, rate, volume, and duration, have triggered a paradigm shift from aggressive hydration with normal saline to goal-directed and non-aggressive hydration with lactated Ringer's solution. Evidence of the clinical benefit of early enteral feeding is becoming definitive. The routine use of prophylactic antibiotics is generally limited, and the procalcitonin-based algorithm of antibiotic use has recently been investigated to distinguish between inflammation and infection in patients with AP. Although urgent ERCP (within 24 h) should be performed for patients with gallstone pancreatitis and cholangitis, urgent ERCP is not indicated in patients without cholangitis. The management approach for patients with local complications of AP, particularly those with infected necrotizing pancreatitis, is discussed in detail, including indications, timing, anatomical considerations, and selection of intervention methods. Furthermore, convalescent treatment, including cholecystectomy in gallstone pancreatitis, lipid-lowering medications in hypertriglyceridemia-induced AP, and alcohol intervention in alcoholic pancreatitis, is also important for improving the prognosis and preventing recurrence in patients with AP. This review focuses on recent updates on the initial and convalescent management strategies for AP.

Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis.

Compared with patients with other causes of acute pancreatitis, those with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are more likely to develop persistent organ failure (POF). Therefore, recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP), a simple parameter that is obtained 24 h after admission, is an ideal index to predict HTG-AP severity; however, the suboptimal sensitivity limits its clinical application. Hence, current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity. To elucidate the early predictive value of red cell distribution width (RDW) for POF in HTG-AP. In total, 102 patients with HTG-AP were retrospectively enrolled. Demographic and clinical data, including RDW, were collected from all patients on admission. Based on the Revised Atlanta Classification, 37 (33%) of 102 patients with HTG-AP were diagnosed with POF. On admission, RDW was significantly higher in patients with HTG-AP and POF than in those without POF (14.4% vs 12.5%, P < 0.001). The receiver operating characteristic curve demonstrated a good discriminative power of RDW for POF with a cutoff of 13.1%, where the area under the curve (AUC), sensitivity, and specificity were 0.85, 82.4%, and 77.9%, respectively. When the RDW was ≥ 13.1% and one point was added to the original BISAP to obtain a new BISAP score, we achieved a higher AUC, sensitivity, and specificity of 0.89, 91.2%, and 67.6%, respectively. RDW is a promising predictor of POF in patients with HTG-AP, and the addition of RDW can promote the sensitivity of BISAP.

Predicting Severity in Hypertriglyceridemia-Induced Acute Pancreatitis: The Role of Neutrophils, Calcium, and Apolipoproteins.

BACKGROUND Hypertriglyceridemia-induced acute pancreatitis (HTG-AP), representing 10% of all acute pancreatitis cases, is characterized by younger onset age and more severe progression, often leading to higher ICU admission rates. This condition poses a significant challenge due to its rapid progression and the potential for severe complications, including multiple organ failure. HTG-AP is distinct from other forms of pancreatitis, such as those caused by cholelithiasis or alcohol, in terms of clinical presentation and outcomes. It's essential to identify early markers that can predict the severity of HTG-AP to improve patient management and outcomes. MATERIAL AND METHODS This study divided 127 HTG-AP patients into mild acute pancreatitis (MAP, n=71) and moderate-to-severe acute pancreatitis (MSAP/SAP, n=56) groups. Blood biological indicators within the first 24 hours of admission were analyzed. Risk factors for HTG-AP progression were determined using binary logistic regression and ROC curves. RESULTS Elevated levels of HCT, NLR, TBI, DBI, AST, Cre, and AMS were noted in the MSAP/SAP group, with lower levels of LYM, Na⁺, Ca²⁺, ApoA, and ApoB compared to the MAP group (p<0.05). NEUT%, Ca²⁺, ApoA, and ApoB were significantly linked with HTG-AP severity. Their combined ROC analysis yielded an area of 0.81, with a sensitivity of 61.8% and specificity of 90%. CONCLUSIONS NEUT%, Ca²⁺, ApoA, and ApoB are significant risk factors for progressing to MSAP/SAP in HTG-AP. Their combined assessment provides a reliable predictive measure for early intervention in patients at risk of severe progression.

Lipid-lowering therapy for hypertriglyceridemia-induced acute pancreatitis: Recent advances

Lipid-lowering therapy for hypertriglyceridemia-induced acute pancreatitis: Recent advances

S2074 Unveiling the Link: Hypertriglyceridemia Induced Acute Pancreatitis in a Young Female on Oral Contraceptives - A Case Report

S2074 Unveiling the Link: Hypertriglyceridemia Induced Acute Pancreatitis in a Young Female on Oral Contraceptives - A Case Report

S12 Head-to-Head Comparison of Alcoholic, Biliary, &amp; Hypertriglyceridemia-Induced Acute Pancreatitis: A Nationwide Analysis

S12 Head-to-Head Comparison of Alcoholic, Biliary, &amp; Hypertriglyceridemia-Induced Acute Pancreatitis: A Nationwide Analysis

NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores.

The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of acute pancreatitis, although the role of the NLR stratified by etiology is still insufficiently studied. However, the NLR's role in mortality prediction was poorly evaluated in the literature. We performed a retrospective, cross-sectional study to analyze the role of NLR0 (at admission) and NLR48 (at 48 hours) in acute pancreatitis as compared with CRP, BISAP, SOFA, and modified CTSI (mCTSI) for the prediction of mortality and severe acute pancreatitis (SAP) in patients admitted into the Emergency Clinical County Hospital of Craiova during 48 months. The primary assessed outcomes were the rate of in-hospital mortality, the rate of persistent organ failure, and ICU admissions. We analyzed mortality prediction for all acute pancreatitis, for biliary, alcoholic, and hypertriglyceridemic acute pancreatitis, for severe forms, and for patients admitted to the ICU. A total of 725 patients were selected; 42.4% had biliary acute pancreatitis, 27.7% had alcoholic acute pancreatitis, and 8.7% had hypertriglyceridemia-induced acute pancreatitis. A total of 13.6% had POF during admission. The AUC for NLR48 in predicting mortality risk and SAP was 0.81 and 0.785, superior to NLR0, CRP48, and mCTSI but inferior to BISAP and SOFA scores. The NLR48/NLR0 ratio did not add significantly to the accuracy. NLR0 and NLR48 performed poorly for mortality prediction in severe forms and in patients admitted to the ICU. NLR48 has good accuracy in our study for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis. NLR48 was a good indicator in predicting mortality risk and severe forms in all patients with acute pancreatitis, but not of death in SAP and in patients admitted to ICU, with good accuracy for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis.

CHARACTERISTICS AND RESULTS OF TREATMENT OF HYPERTRIGLYCERIDEMIA-INDUCED ACUTE PANCREATITIS AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: After alcohol and gallstones, hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). Hypertriglyceridemia is triglyceridemia concentration &gt;150mg/dl (1.7mmol/l). Severe hypertriglyceridemia &gt;1000mg/dl (11.3 mmol/l) is considered the cause of AP. Objectives: To compare some clinical and subclinical features and results of treatment of AP with two levels of hypertriglyceridemia &lt;11.3mmol/l and &gt;I1.3mmol/l at the Department of General Internal Medicine in Can Tho University of Medicine and Pharmacy Hospital. Materials and methods: This was a cross-sectional descriptive study of 33 patients who were admitted to the hospital with hypertriglyceridemia-induced AP. Results: Clinical symptoms and some laboratory tests did not differ between the two groups. Statistically significant differences occurred in the 2 groups as blood CRP value with p=0.009, low sodium levels 134.22±4.73mmol/l and high BMI levels 26.63±5.15kg/m2 in the group with TG ≥ 11.3 mmol/l. The rate of amylase increased 3 times in the high-TG group was 85.2%. Both groups had elevated glucose and LDH levels respectively, with 10.56±5.13 mmol/l and 310.64±206.01U/L. Ultrasound diagnosis of acute pancreatitis reached 100%, CTSI and BISAP index were high in the group with TG ≥11.3mmol/l. The days of using insulin and staying in the hospital were significantly different, with p=0.004 and p=0.014. Conclusions: Comparing the 2 groups of acute pancreatitis with blood TG &lt;11.3mmol/l and ≥11.3mmol/l, there was no difference in clinical symptoms. Mean values of sodium, BMI and blood CRP (p=0.009) were different between the two groups of acute pancreatitis. Treatment results in days of using insulin and staying in the hospital had statistically significant differences between the 2 groups.

Dynamic nomogram for predicting infected pancreatic necrosis in female patients of childbearing age with hypertriglyceridemia-induced acute pancreatitis

BackgroundHypertriglyceridemia is a common cause of acute pancreatitis. Pregnant women are at risk of developing hypertriglyceridemia-induced acute pancreatitis (HTG-AP); however, whether pregnancy increases the risk of infected pancreatic necrosis (IPN) is unknown. AimWe aimed to assess the association between pregnancy and IPN. MethodsThis 10-year retrospective cohort study was conducted at Jinling Hospital. Adult female patients of childbearing age with HTG-AP between January 2013 and September 2022 were screened. Logistic regression analyses were performed to assess the risk factors for IPN. Patients admitted within 7 days were assigned to the training and validation sets to develop a dynamic nomogram for IPN prediction. Results489 patients were included, and 144 developed IPN. Logistic regression analyses revealed pregnancy (OR: 2.578 95% CI: 1.474–4.510) as an independent risk factor for IPN. Gestation weeks, ARDS, albumin level, and serum creatinine level were selected as the predictors of the dynamic nomogram for IPN prediction, with good discrimination in the training set (AUC 0.867 95% CI: 0.794–0.940) and validation set (AUC 0.957 95% CI: 0.885–1.000). ConclusionPregnancy increases the risk of IPN in adult patients of childbearing age with HTG-AP, and the dynamic nomogram may help risk stratification for IPN.

Hypertriglyceridemia-Induced Acute Pancreatitis Secondary to Glycogen Storage Disease Type Ia: Successful Treatment With Plasmapheresis

Hypertriglyceridemia-Induced Acute Pancreatitis Secondary to Glycogen Storage Disease Type Ia: Successful Treatment With Plasmapheresis

The Case Files

The Case Files

Abstract #1411391: An Untoward Case of Diabetic Ketoacidosis and Hypertriglyceridemia Pancreatitis in a Young Type 2 Diabetes Patient

In the US, every year, there are around 60 cases of Diabetic ketoacidosis (DKA) admissions seen per 10,000 admissions and out of which the mortality rate is only 0.38%. The enigmatic triangle of diabetic ketoacidosis (DKA) with concurrent hypertriglyceridemia-induced acute pancreatitis is an uncommon phenomenon. This rare combined presentation can lead to detrimental outcomes in diabetes mellitus (DM) patients. The patient is a 21-year-old male with a previous history of prediabetes who presents to the ED with complaints of epigastric abdominal pain, nausea, and non-bloody vomiting for two days. In the ED, afebrile, tachycardic, and tachypneic saturating well on room air. His blood pressure was stable. His vitals, physical examination findings were normal. On admission, patient was dehydrated with hemoglobin 19.7, WBC count 25k, BUN 37, creatinine 1.83. Blood glucose 833. His hemoglobin A1c 12.4, positive ketones in serum and urine, anion gap 32, bicarbonate 8, pH of 7.16. TSH 0.64. His levels of lipase 13k and triglycerides 1428. Sepsis workup was negative for any source of infection. Fluid resuscitation to up to 5 liters of fluids was given, was started on an insulin drip. The patient was transferred to ICU and was still tachycardic in the 180s, so adenosine, metoprolol, and diltiazem were given. It improved to the 150s. An hour later, he was more confused and was intubated for airway protection. Around 30 minutes later, he went into cardiac arrest and achieved ROSC. He was then on maximum vasopressor support and eventually had two more cardiac arrests and passed away. Even though the management for both DKA and hyperlipidemia pancreatitis may be similar with insulin administration, when they present together, it can be catastrophic and lead to systemic complications like SIRS, pancreatic necrosis, abdominal compartment syndrome, and even death. This is an example of how this combination led to severe outcomes cascading over the hospital course, which led to the mortality of a young type 2 DM patient.

Effect of Plasma Exchange Treatment in Patients with Hypertriglyceridemia-Induced Acute Pancreatitis.

Background and Objectives: To describe the clinical and biological characteristics of patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) and to evaluate the effectiveness of therapeutic plasma exchange (TPE) in the management of HTG-AP. Materials and Methods: A cross-sectional study was conducted on 81 HTG-AP patients (30 treated with TPE and 51 treated conventionally). The main outcome was a decrease in serum triglyceride levels (<11.3 mmol/L) within 48 h of hospitalization. Results: The mean age of participants was 45.3 ± 8.7 years, and 82.7% were male. Abdominal pain was the most frequent clinical sign (100%), followed by dyspepsia (87.7%), nausea or vomiting (72.8%), and a bloated stomach (61.7%). The HTG-AP patients treated with TPE had significantly lower calcemia and creatinemia levels but higher triglyceride levels than those who received conservative treatment. They also had more severe diseases than those treated conservatively. All patients in the TPE group were admitted to the ICU, whereas the ICU admission rate in the non-TPE group was 5.9%. The TPE patients were more likely to experience a rapid decrease in triglyceride levels within 48 h of treatment than those treated conventionally (73.3% vs. 49.0%, p = 0.03, respectively). The decrease in triglyceride levels did not depend on the age, gender, or comorbidities of the HTG-AP patients or the severity of disease. However, TPE and early treatment in the first 12 h of disease onset were effective in rapidly reducing serum triglyceride levels (adjusted OR = 3.00, p = 0.04 and aOR = 7.98, p = 0.02, respectively). Conclusions: This report demonstrates the effectiveness of early TPE in reducing triglyceride levels among HTG-AP patients. More randomized clinical trials studies with a large sample size and post-discharge follow-up are needed to confirm the effectiveness of TPE methods in managing HTG-AP.

Honokiol reduces oxidative stress by activating the SIRT3-MnSOD2 pathway to alleviate hypertriglyceridemia-induced acute pancreatitis in rats

To determine how honokiol affects the sirtuin-3 (SIRT3)-MnSOD2 pathway and oxidative stress in rats with hypertriglyceridemia-induced acute pancreatitis (HTGP). Thirty 4-week-old male SD rats were randomly divided into two groups for normal feeding and high-fat feeding for 4 weeks, after which the rats with normal feeding were randomized into control group and acute pancreatitis (AP) group (n=6), and those with high-fat feeding were divided into hypertriglyceridemia group, HTGP group, and honokiol treatment group (n=6). In AP, HTGP, and honokiol groups, AP models were established by intraperitoneal injection of cerulean; in honokiol group, the rats received an intraperitoneal injection of 5 mg/kg honokiol 15 min after cerulean injection. Serum TG, IL-6, and TNF-α levels were measured 24 h after the treatments, and pathological changes in the pancreas were observed with HE staining; The levels of reactive oxygen species (ROS), malondialdehyde (MDA), and glutathione peroxidase (GSH) were measured, and SIRT3 and manganese superoxide dismutase (MnSOD2) expressions were detected using Western blotting and immunohistochemistry. Transmission electron microscopy was used to examine the ultrastructure of pancreatic acinar cells and mitochondria. Compared with the those with normal feeding, the rats with high-fat feeding had significantly elevated serum TG level (P < 0.05). The rat models of AP showed significantly increased serum levels of IL-6, TNF-α, and MDA and decreased GSH level and expressions of SIRT3 and MnSOD2, with obvious edema and inflammatory cell infiltration and enhanced ROS fluorescence intensity in the pancreas and ultrastructural damages of the acinar cells and mitochondria. In rats with HTGP, honokiol treatment significantly decreased serum levels of IL-6, TNF-α, and MDA, increased GSH level and SIRT3 and MnSOD2 expressions, reduced ROS production, and alleviated ultrastructural damage of the acinar cells and mitochondria in the pancreas. Honokiol reduce oxidative stress and alleviates pancreatic injuries in HTGP rats possibly by activating the SIRT3-MnSOD2 pathway.

Effectiveness of an Intravenous Insulin-Based Treatment Protocol for the Management of Hypertriglyceridemia-Associated Acute Pancreatitis.

There is burgeoning interest in intravenous insulin for hypertriglyceridemia-induced acute pancreatitis (HTG-AP) as a less invasive alternative to plasmapheresis; however, there are few published descriptions of disease-specific insulin protocols. To compare the efficacy and safety of an insulin infusion-based protocol with nonstandardized medical therapy for HTG-AP. This is a retrospective analysis before and after creation of an HTG-AP-specific insulin infusion treatment protocol. Inclusion criteria were age ≥18 years, an initial triglyceride level >1000 mg/dL, and a diagnosis of AP. The primary outcome of the study was time to a triglyceride level ≤1000 mg/dL. Sixty-seven patients were included in this study (26 pre-protocol and 41 in the HTG-AP insulin protocol group). Baseline characteristics between the groups were similar, with median initial triglyceride levels >3500 mg/dL. There was a trend toward patients treated with the HTG-AP-specific infusion reaching a triglyceride level ≤1000 mg/dL faster (43.3 [24.9-72.1] vs 26.9 [17.7-51.1] hours; P = 0.07). Those treated to ≤500 mg/dL achieved this faster with the disease-specific infusion (49.2 [29.4-67.8] vs 70.9 [36.3-107.2] hours, P = 0.04). Hypoglycemia was numerically lower in the HTG-AP-specific insulin infusion group despite higher insulin infusion rates (7.3% vs 19.2%). No patient in the HTG-AP-specific protocol group required plasmapheresis. The use of an HTG-AP-specific insulin infusion protocol, compared with antecedent nonstandardized care, resulted in prompter achievement of a triglyceride level ≤500 mg/dL and a strong trend toward faster achievement of ≤1000 mg/dL without an increased risk of hypoglycemia. While intravenous insulin may be considered the initial medical therapy for HTG-AP, further studies are needed to determine the optimal dosing.

Hypertriglyceridemia-induced Acute Pancreatitis in Diabetic Population

Hypertriglyceridemia induced acute pancreatitis has become the third major cause of acute pancreatitis resulting in high morbidity and mortality. Currently, specific mechanism behind association between hypertriglyceridemia in diabetic population and the correlation of causing acute pancreatitis are still not well identified. This literature review summarizes recent understanding of the pathogenesis of hypertriglyceridemia in diabetic populations and its correlation with acute pancreatitis along with clinical management of this disease. Keywords: Hypertriglyceridemia, Pancreatitis, Diabetic Population

Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis.

Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP. Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269. From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively). This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.

219: EVALUATION OF HIGH-DOSE INSULIN FOR THE TREATMENT OF HYPERTRIGLYCERIDEMIC PANCREATITIS

Introduction: Acute pancreatitis is a common inflammatory condition with several underlying etiologies, including hypertriglyceridemia induced. The risk for acute pancreatitis increases when the serum triglyceride levels exceeds more than 1000 mg/dL. Insulin therapy is a feasible therapeutic option to help lower triglyceride levels to minimize the complications of acute pancreatitis. The aim of this medication use evaluation is to characterize the use of high-intensity insulin to assess its use in hypertriglyceridemia induced acute pancreatitis. Methods: A single-center, retrospective, observational study at a large academic medical center will be conducted. All patients admitted to the medical intensive care unit from September 1st, 2018 to September 30th, 2021 who received high-dose insulin drip for hypertriglyceridemia-induced acute pancreatitis will be eligible for inclusion. The primary objective of this study is to assess the efficacy of using high-dose insulin drip for the treatment of hypertriglyceridemic pancreatitis with a secondary objective to evaluate the safety of high-dose insulin in this setting. Results: Only 27 patients met inclusion criteria. Twenty patients reached a triglyceride goal of less than 500 with only 9 patients experiencing hypoglycemic episodes. Each patient evaluated in this study had some reduction of their triglycerides after starting an insulin infusion. Seven patients received insulin plus plasmapheresis episodes. The average duration of insulin infusion was 70 hours with an average total insulin use of 435 units. Conclusions: All patients who received high-dose insulin infusion for hypertriglyceridemia-induced acute pancreatitis had reduction in their triglyceride levels after starting insulin infusion with 74% of patients reaching a goal triglyceride level less than 500. Only 7 patients evaluated in this study received insulin infusion plus plasmapheresis episode and the duration, total average units, and average units/hr of insulin were lower in the insulin plus plasmapheresis group compared to insulin alone group, however, no comparable data available in the literature at this time. Future studies comparing insulin and insulin in addition to plasmapheresis are needed to further analyze optimal treatment for hypertriglyceridemia induced pancreatitis.