A 24‐year‐old woman without chronic medical comorbidity presented with acute‐onset epigastric abdominal pain radiating to her back after a meal at a fast‐food restaurant. The patient had never experienced similar symptoms, but other family members had “high cholesterol” and pancreatitis. She was using a vaginal estradiol ring for contraception. She reported binge drinking alcohol on weekends. On admission, examination revealed a low‐grade temperature of 100°F and tachycardia. She was obese (BMI 30 kg/m2), with epigastric abdominal tenderness. No xanthelasma or tendinous xanthomas were noted. Laboratory results were significant for multiple “cancelled” values on three consecutive blood draws; potassium, bilirubin, aminotransferases, alkaline phosphatase, and lipase were all ordered but reported as cancelled by the laboratory. The next blood draw revealed a triglyceride level of 2540 mg/dL and a lipase level of 177 U/L, along with persistently cancelled values for all other chemistries. She was diagnosed with hypertriglyceridemic pancreatitis (HTGP) and transferred to the step‐down unit for insulin and dextrose infusions to mitigate her triglyceride level. Fibrate therapy was initiated, and her vaginal estradiol ring was discontinued. Her triglyceride level normalized, pancreatitis symptoms remitted, and she was discharged with arrangements to follow up in the endocrinology clinic.
HTGP is an uncommon (approximately 5%) but well‐documented cause of acute pancreatitis. Triglyceride levels of at least 1000 mg/dL are thought to be necessary to cause HTGP, though there is no direct correlation between triglyceride level and severity of HTGP. Causes of hypertriglyceridemia are varied, including primary (genetic disorders of lipid metabolism) and secondary (diabetes, obesity, thyroid disorders, and medications). Our patient's hypertriglyceridemia was thought multifactorial, with contributions from a possible familial dyslipidemia, estrogenic contraception, obesity and diet. A commonly encountered but incompletely described clinical phenomenon is the association between lipemia and difficulties in measurement of many laboratory indices. There are known effects of hypertriglyceridemia on sodium, amylase, and low‐density lipoprotein calculation; however, most clinical laboratories will frequently defer reporting common tests (hence the “cancelled” values) and in some cases note overt lipemia.
(1) HTGP is an uncommon but well‐documented cause of acute pancreatitis, the interventions for which may require a higher level of care than a general medicine ward. (2) Repeated cancellation of routine laboratory indices should raise suspicion as to the possibility of hypertriglyceridemia.
To cite this abstract:Sankey C, Apgar S. Laboratory Abnormalities As a Clue to Hypertriglyceridemic Pancreatitis. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 496. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/laboratory-abnormalities-as-a-clue-to-hypertriglyceridemic-pancreatitis/. Accessed March 29, 2020.