Treating hypertriglyceridemia
=============================

* Georg Röggla MD
* Michael Fasan MD
* Stylianos Kapiotis MD

*   © 2007 Canadian Medical Association or its licensors

In their review of hypertriglyceridemia, George Yuan and colleagues advocate “hemodynamic stabilization, cessation of all oral intake, placement of a nasogastric tube and control of metabolic disturbances” to treat triglyceride-related acute pancreatitis.1 The authors are skeptical about the use of plasmapheresis because it provides only a transient benefit.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/177/6/603.1/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/177/6/603.1/F1)

**Figure 1:** Serum of a patient with triglyceride-related acute pancreatitis. Left: Lipemic serum before treatment with insulin and heparin. Right: Clear serum after 5 days of therapy.

We use a different treatment method (heparin and insulin infusions to stimulate lipoprotein lipase activity and therefore reduce serum triglyceride levels2)as the first-line therapy in our hospital, as described in the following case. A 29-year-old man with an uneventful medical history was admitted to hospital because of severe abdominal pain with a clinical diagnosis of acute pancreatitis. The fasting triglyceride level was nearly 8000 mg/dL at admission. In addition to standard therapy for pancreatitis, an insulin infusion was started at 4 IU/h with glucose substitution as necessary. Low-molecular-weight heparin was also administered. Within 5 days the patient was asymptomatic and his triglyceride level had decreased to 450 mg/dL. His lipemic serum had a milky appearance at admission and a nearly normal clear appearance on day 5 (Figure 1). Case series and case reports describing the treatment of pancreatitis with heparin and insulin have been published,3–5 but the efficacy of this treatment method has not yet been well established, presumably because of the lack of controlled trials.

## Footnotes

*   **Competing interests:** None declared.

## REFERENCES

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