Abstract #1406325: The Complexities of Managing Hypertriglyceridemia-Induced Pancreatitis in a Critically-Ill COVID-19 Patient

Hypertriglyceridemia-induced pancreatitis (HTP) is a variant of requiring unique management. The complications COVID-19 and its treatments can make HTP therapy more nuanced. This case describes patient who presented in diabetic ketoacidosis (DKA) with HTP, COVID-19. developed renal respiratory failure, necessitating hemodialysis (HD) extracorporeal membrane oxygenation (ECMO), complicating an otherwise straightforward medical management plan. A morbidly obese (BMI 38.9 kg/m2) 43-year-old male to outside hospital abdominal pain, vomiting, was found have triglycerides (TG) >2000 mg/dL (<149 mg/dL) presumed new-onset type 2 Diabetes (HbA1c 10.9%) DKA. Treatment fluids, intravenous (IV) insulin infusion plasmapheresis were initiated. He hypoxia after receiving over 17 liters fluids intubated, subsequently developing failure transferred our tertiary center for HD ECMO. On admission, he tested positive COVID-19, rhabdomyolysis [creatinine kinase 5600 U/L (30-200 U/L)], [TG 783 mg/dL), lipase 461 U/l (7-60 glucose 269 (not DKA), transaminitis [AST 184 (4-40 U/L), ALT 61 (4-41 U/L)] (GFR 10 ml/min/1.73m2). IV initiated hyperglycemia worsened by dexamethasone treatment. Plasmapheresis performed twice minimal effect at maintaining low TG. Fenofibrate not due failure; Lovaza could be given via oral gastric tube; Atorvastatin attempted once resolved, subsequent worsening liver function tests. Heparin deep vein thrombosis treatment but stopped development heparin induced thrombocytopenia. hypoglycemia cessation insulin, hypotension maximum pressor support, sepsis leading his death. illustrates the challenges managing It demonstrates how normally algorithm become increasingly complex when factoring patient’s comorbid conditions. highlights importance knowing both indications contraindications HTP. In this case, may been initial diagnosis, most endocrinologists, conditions ultimately made landscape challenging, limiting effective demise.