AN UNUSUAL CASE OF RECURRENT HYPERTRIGLYCERIDEMIC PANCREATITIS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hypertriglyceridemia (HTG) induced recurrent acute pancreatitis (RAP) is a rare entity. Its occurrence with normal pancreatic enzyme levels has not been commonly reported. Herein, we report case of RAP secondary to hypertriglyceridemia blood lipase level. CASE PRESENTATION: A 48-year old male history presented 72-hour right upper quadrant (RUQ) and epigastric abdominal pain. He had hypertriglyceridemic 5 years ago, however was compliant treatment. On presentation, he febrile RUQ tenderness. His laboratory investigations revealed: white cell 10.59 x 10^9/L, sodium 133mmol/L, carbon dioxide 18mmol/L, creatinine 0.7 mg/dL, glucose 138 mg/dL calcium 8.8mg/dL; albumin 4.2g/dL, total bilirubin 1.9mg/dL, alanine transferase 37u/L, aspartate 60u/L, alkaline phosphatase u/L. Triglycerides were significantly elevated at >2,625mg/dL serum 113 u/L (normal 23-300). CT scan the abdomen pelvis revealed extensive inflammatory stranding centered head uncinate process pancreas, consistent pancreatitis. received intravenous crystalloids, opioids continuous insulin infusion which discontinued on day 4 once triglyceride level <500. started gemfibrozil discharged home. DISCUSSION: With an incidence 13–45/100,000 one most common diagnoses for contacting emergency services hospitalization in Europe USA. Acute (AP) defined by two three criteria: typical belt-like pain, times above threshold, or radiological imaging signs as 2 more attacks AP without any evidence chronic HTG third-most common, possibly underestimated missed, cause it accounts 1%–7% cases. Serum amylase can be hypertriglyceridemia-induced pancreatitis, but sensitive specific than diagnosis AP. Normal AP, this case, rare. Several studies have reported negative predictive value diagnosing between 94 100 percent. CONCLUSIONS: Though uncommon, Pancreatitis present biomarkers, if suspicion high, should pursued confirm exclude diagnosis. REFERENCE #1: Weiss, F. U., Laemmerhirt, F., & Lerch, M. (2019). Etiology Risk Factors Chronic Pancreatitis. Visceral medicine, 35(2), 73–81. https://doi.org/10.1159/000499138 #2: Kumar, P., Ghosh, A., Sinha, N., Tonk, R. S. (2018). Secondary Causing Recurrent Pancreatic Enzymes. Indian journal critical care medicine : peer-reviewed, official publication Society Medicine, 22(5), 381–383. https://doi.org/10.4103/ijccm.IJCCM_353_17 #3: Shah, A. M., Eddi, R., Kothari, T., Maksoud, C., DiGiacomo, W. S., Baddoura, (2010). lipase: series. JOP Journal 11(4), 369–372 DISCLOSURES: No relevant relationships Janeen Grant-Sittol, source=Web Response Fausto Lisung, Anna-Belle Robertson, Rani Sittol,