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Rheologic reflection in hypertriglyceridemia-induced pancreatitis.
Donald Martin1, Edward McCann, Patrick Glynn
1Department of Internal Medicine, Wright State University, Good Samaritan Hospital, Dayton, OH, USA. Donald.martin@lakenheath.af.mil
Southern Medical Journal
|September 10, 2009
Summary
Severe acute hypertriglyceridemia can cause pancreatitis. Plasmapheresis before continuous venovenous hemodialysis (CVVHD) may prevent dialysis failure in these critical cases.
Area of Science:
- Nephrology
- Gastroenterology
- Critical Care Medicine
Background:
- Severe acute hypertriglyceridemia, with triglyceride levels exceeding 1,000 mg/dL, is a known cause of acute pancreatitis.
- Emerging evidence supports plasmapheresis as a treatment to reduce triglyceride levels in pancreatitis.
- Continuous venovenous hemodialysis (CVVHD) is often used for fluid management in critically ill patients, but severe lipemia can impede its function.
Observation:
- A case of severe acute hypertriglyceridemia-induced pancreatitis is reported where CVVHD failed due to severe lipemia.
- Plasmapheresis was required in the early phase of treatment to manage the high triglyceride levels and enable effective dialysis.
Findings:
- The study highlights the potential for severe lipemia to cause rheologic failure in CVVHD circuits.
- Initiating plasmapheresis before CVVHD in patients with hypertriglyceridemia-induced pancreatitis and an urgent need for dialysis may prevent device failure.
Implications:
- This suggests a modified approach to renal replacement therapy in severe hypertriglyceridemia-induced pancreatitis.
- Considering plasmapheresis as a pre-emptive measure could improve outcomes and reduce complications associated with dialysis in this specific patient population.
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