Stony Brook University Hospital
Stony Brook, NY
Hospital course was complicated by alcohol withdrawal, respiratory distress, and persistent fevers. Patient was intubated and started on Meropenem for concern over aspiration pneumonia versus necrotizing pancreatitis. A repeat CT of the abdomen/pelvis showed an edematous pancreatitis without evidence of necrosis or abscess formation. Patient was successfully treated for both pancreatitis and pneumonia, and discharged on hospital day 14 on omeprazole and fenofibrate.
Discussion: While TGL themselves are not toxic to the pancreas, it is their break-down into fatty-free acids by pancreatic lipase that causes toxicity. Thus, higher TGL levels confer higher risk of developing pancreatitis. In this case, patient was started quickly on an insulin drip, and his TGL decreased profoundly without need for apheresis. There have been several case reports of TGL-induced pancreatitis that were treated successfully with insulin therapy alone. However, in those cases, it took 6 days of insulin therapy until goal levels were achieved. In this presented case, goal levels were achieved by day 3.
Michelle Sheyman indicated no relevant financial relationships.
Rashmi Advani indicated no relevant financial relationships.
Tyson Collazo indicated no relevant financial relationships.