Editing Acute pancreatitis (section)

== '''Hypertriglyceridaemia pancreatitis:''' ==

* A patient with epigastric pain and high triglycerides (>20 or so) probably has hypertriglyceridaemia pancreatitis, even if their lipase is normal or only mildly elevated. The lipaemic blood can mess with the results and probably underestimates the true lipase level.
* Lipotoxicity caused by pancreatic metabolization of trigs into free fatty acids by pancreatic enzymes
* Most common in south Asian patients
* Anyone with triglycerides >11mmol/L is high-risk
** 5% risk of developing it with trig > 11.3, 10-20% with trig > 22.6
* If 'worrisome features' (lactic acidosis, end-organ dysfunction, >= 2 SIRS criteria, or hypocalcaemia) need apharesis
* Otherwise treat with insulin infusion until triglycerides <5.6 mmol/L
** BD triglycerides and K+
** Set rate insulin infusion - generally 3 units per hour is reasonable, with concurrent 5% glucose, target BSL 6-15
** Check BSL and ketones prior
** NBM or clear fluids to start with
** Once triglycerides down <10, common practice to cease infusion (sometimes switch to subcut insulin) and start fenofibrate/fish oil)
* Needs long-term follow-up with endocrinologist and medical r/v while inpatient for long-term lipid control