AIMS
Hypertriglyceridaemia is a rare cause of acute pancreatitis (AP). It is worsened by alcohol excess and poorly controlled diabetes mellitus (DM). There are no recommended guidelines for management, which leads to poor treatment. This audit reviews the management of hypertriglyceridaemia-induced AP over eight-years.
METHODS
A two-centre retrospective study was conducted for AP over 8.75years. Management of those with elevated triglyceride levels (defined as ≥6mmol/L) on admission was reviewed. Data was collected from electronic records.
RESULTS
Between 01-Nov-2011 and 31-Jul-2020, there were 3850 presentations of AP to either Gold Coast Hospital or Robina Hospital. 75 presentations (1.94%) between 51 patients had elevated triglycerides during admission (mean 52.4 ±47.9mmol/L). 81.3% had documentation that hypertriglyceridaemia was the major contributing cause, whilst the rest were documented as secondary to acute alcohol ingestion despite elevated triglycerides.
Average length of hospitalisation was 8.45days often under general surgical team. Average patient was 41.92years with BMI of 30.4. All were fasted with IV fluids with 32% requiring insulin infusion and 9% needing plasma exchange. 22.6% required intensive care admission. 4% required surgical intervention. There was 1 death, due to concomitant sepsis.
In the 42 cases where family history was obtained, diabetes mellitus (21.4%) and hyperlipidaemia (64.2%) were common. Pre-existing diabetes mellitus affected 50.7%, however HbA1c was measured in only 38.7% (mean 8.73% ±3.07%). There was a high recurrence of AP, with 58.6% having either prior or future episodes.
Endocrinologist opinion was obtained in 42.7% and dietician review in 48%. Only 76% left hospital on pharmacological therapy.
CONCLUSION
Whilst hypertriglyceridaemia is a rare cause of AP, it can be mismanaged with lack of specialist or dietician opinion, and patients can be discharged without pharmacotherapy. This increases recurrence leading to worsening morbidity.