ASYMPTOMATIC SEVERE HYPERTRIGLYCERIDEMIA: REACHING A NEW THRESHOLD

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Very severe hypertriglyceridemia (HTG), defined by the Endocrine Society as serum triglyceride (TG) concentration ≥2000 mg/dL, is a rare condition that associated with genetic causes including familial chylomicronemia syndrome or type 1 hyperlipoproteinemia, and secondary conditions uncontrolled diabetes excessive alcohol use. The most feared complication of very HTG acute pancreatitis (AP), rapid lowering TG levels essential in symptomatic patients. It less clear how to approach patients present without concerning clinical manifestations HTG. We case an asymptomatic patient who presented level over 7000 requiring prolonged ICU stay achieve target levels. CASE PRESENTATION: A 25 year-old male no past medical history emergency department complaining diffuse pruritic rash for two weeks. He was found be diabetic ketoacidosis (DKA) initiated on insulin infusion. His initial registered above limit detection at greater than 4425 mg/dL. Lipase within normal limits 20 U/L. Patient denied any abdominal symptoms his exam remained benign. By following day, DKA had resolved, but infusion continued persistently elevated level. 7 days before could lowered 1000 DISCUSSION: mg/dL commonly suggested reduce risk developing AP, this value based primarily expert opinion. Our patient's extrapolated he required extended desired target. Multiple theories have been explain hydrolysis free fatty acids pancreas resulting inflammation, plasma hyperviscosity causing ischemia local acidosis pancreatic capillaries. clearer understanding underlying mechanism might lead better stratification identification are more likely benefit from aggressive Of note, study 129 AP mean 4470 vs 2450 suggesting threshold develop higher believed. CONCLUSIONS: Asymptomatic require lower More investigation needed identify suitable target, avoid unnecessary utilization resources. REFERENCE #1: Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation Treatment Hypertriglyceridemia: An Clinical Practice Guideline. Journal Endocrinology & Metabolism. 2012;97(9):2969-2989. #2: Schaefer EW, Leung A, Kravarusic J, Stone NJ. Management hospital: review. Hospital Medicine. 2011;7(5):431-438. #3: Lloret Linares C, Pelletier AL, Czernichow S, Acute Pancreatitis Cohort Patients Referred Severe Hypertriglyceridemia. Pancreas. 2008;37(1):13-12. DISCLOSURES: No relevant relationships Argun Can, source=Web Response Elana Roadcloud,