Patient with gemfibrozil-controlled hypertriglyceridemia that developed acute pancreatitis after starting ketogenic...

To report the case of a patient with gemfibrozil-controlled hypertriglyceridemia (HTG) that developed acute pancreatitis several days after starting a high-fat ketogenic diet.

The patient was evaluated and treated by the authors.

The patient denied viral prodrome or previous symptoms, ethanol consumption, or a known history of cholelithiasis. He was compliant with his gemfibrozil regimen. Clinical examination revealed a tachycardic, febrile, moderately distressed man with exquisite tenderness across the left flank and left abdomen. Laboratory studies revealed increased serum amylase (114 U/L), lipase (530 U/L) and triglyceride (>1000 mg/dL) concentrations. There was a borderline leukocytosis (12800 WBC/mm(3)). Computed tomography of the abdomen demonstrated enlargement and marked inflammatory change to the pancreas. Abdominal ultrasonography revealed no evidence of cholelithiasis or pancreatobiliary obstruction. These findings were diagnostic of HTG-induced acute pancreatitis.

Ketogenic diets may cause a substantial increase in serum triglycerides and, as a result, may precipitate HTG-induced pancreatitis in those with abnormal lipid metabolism. Patients with a history of HTG should be advised of the potentially deleterious correlation between ketogenic diets and pancreatic function.