From the Guidelines
Rapid reduction of hypertriglyceridemia in acute pancreatitis can be achieved through avoidance of lipid emulsions, drug therapy, and plasma exchange or lipoprotein apheresis.
Methods to Reduce Hypertriglyceridemia
- Avoidance of lipid emulsions: If parenteral nutrition is needed, it is essential to avoid lipid emulsions to prevent further increase in triglyceride levels 1.
- Drug therapy: If serum triglyceride levels cannot be maintained below 12 mmol/L, drug therapy is indicated to decrease VLDL production and prevent more severe hypertriglyceridemia 1.
- Plasma exchange or lipoprotein apheresis: These methods can be used to lower lipid and pancreatic enzyme levels, and improve the signs and symptoms of acute pancreatitis, with lipoprotein apheresis being more effective 1.
Monitoring and Management
- Regular monitoring of serum triglycerides: If lipids are administered, serum triglycerides must be monitored regularly to avoid hypertriglyceridemia 1.
- Maintaining normal triglyceride levels: The goal is to maintain triglyceride levels within the normal range to prevent further pancreatic damage 1.
From the Research
Methods to Rapidly Reduce Hypertriglyceridemia in Acute Pancreatitis
The following methods can be used to rapidly reduce hypertriglyceridemia in acute pancreatitis:
- Conservative management, including nothing by mouth, intravenous fluid resuscitation, and analgesia, which is sufficient to achieve triglyceride levels less than 500 mg/dl in most cases of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) 2
- Intravenous insulin, which can rapidly reduce triglyceride levels, especially in diabetic patients 3, 4
- Plasmapheresis, also known as therapeutic plasma exchange (TPE), which can directly remove pathogenic substances and rapidly lower plasma triglycerides, but its role is not firmly established and it is not widely available 3, 5
- Combined use of insulin and heparin, especially low molecular weight heparin (LMWH), which remains an acceptable therapeutic option in early stages of HTG-AP 3
- Medium chain triglycerides, omega-3-fatty acids, fibrates, niacin, microsomal transport protein inhibitors, and gene therapy, which may be potential adjuvant therapies for achieving permanent control of HTG-AP 3
Lifestyle Modifications and Dietary Changes
Lifestyle modifications and dietary changes also play a crucial role in reducing hypertriglyceridemia, including:
- Cessation of alcohol consumption 6
- Reduced intake of rapidly metabolized carbohydrates 6
- Weight loss 6
- Blood sugar control 6
- Dietary modifications to avoid secondary factors that worsen triglyceride levels 2
Pharmacological Management
Pharmacological management of hypertriglyceridemia should start early and target triglyceride levels of less than 500 mg/dl to reduce the risk of recurrent acute pancreatitis, including: