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Hypertriglyceridemia Induced Pancreatitis: Inpatient Management at a Single Pediatric Institution
Holly M Ippisch1, Ligia Alfaro-Cruz2, Lin Fei3
1From the Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Hypertriglyceridemia-induced pancreatitis in children lacks guidelines. Management strategies like NPO, IV fluids, insulin, and plasmapheresis effectively lowered triglycerides, with NPO showing faster reduction.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Critical Care Medicine
Background:
- Hypertriglyceridemia-induced acute pancreatitis (AP) is a significant pediatric concern.
- Established management guidelines for this condition in children are lacking.
- This study reviews management approaches at a single pediatric center.
Purpose of the Study:
- To review and analyze management strategies for pediatric patients with hypertriglyceridemia-induced AP.
- To identify factors influencing triglyceride reduction in this patient population.
Main Methods:
- Retrospective study of pediatric inpatients (<21 years) with AP and triglycerides (TG) ≥1000 mg/dL.
- Analysis of diet (NPO vs. early nutrition), intravenous fluid (IVF) rates, insulin, and plasmapheresis.
- Linear mixed-effects model to assess TG reduction.
Main Results:
- Seventeen admissions in 8 patients (average age 15) were analyzed.
- Fifty percent experienced recurrent AP; 29% had complications, including one death.
- NPO, higher IVF rates, plasmapheresis, and insulin were associated with significant TG reduction (P < 0.05).
- NPO demonstrated faster TG reduction compared to early nutrition initiation.
Conclusions:
- Hypertriglyceridemia is a key cause of pediatric pancreatitis.
- A single institution's management algorithm for hypertriglyceridemia-induced AP is presented.
- Further research is needed to develop evidence-based guidelines.
Objectives:
Hypertriglyceridemia-induced pancreatitis is an important cause of acute pancreatitis (AP) in children, which lacks established guidelines. The aim of this study was to review management approaches at a single pediatric center.
Methods:
This retrospective study included all inpatients younger than 21 years with AP and triglycerides (TG) of 1000 mg/dL or greater. A linear mixed effect model was used to calculate drop in TGs. The patient's diet, intravenous fluid (IVF) rate, insulin, and plasmapheresis were included in the model.
Results:
Seventeen admissions were identified among 8 patients, average age 15 years (range, 6-19 years). Fifty percent had recurrent AP and 29% of admissions had complications including 1 death. The population was primarily female (75%), white (75%), and overweight, and 63% had diabetes. The median stay was 5.4 days. There were 14 approaches used with variations in IVF rates, insulin, plasmapheresis, and nill per os (NPO) versus feeds. Variables that reduced TG's were NPO, higher IVF rates, plasmapheresis, and insulin (P < 0.05). Importantly, NPO reduced TGs faster than those who started early nutrition.
Conclusions:
Hypertriglyceridemia is an important cause of pancreatitis in children. This study shares a management algorithm from a single institution. Larger studies are needed for more evidence-based guidelines.
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