Related Experiment Video
Updated: Aug 28, 2025
Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct
Published on: April 1, 2022
Hypertriglyceridemia-induced acute pancreatitis in children: A mini-review
John M Grisham1, Andrew H Tran2,3, Kate Ellery4
1Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, United States.
Insights
Severe hypertriglyceridemia (HTG) can cause acute pancreatitis (AP) in children. Management guidelines for pediatric hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are not well established, unlike in adults.
Area of Science:
- Pediatric Gastroenterology
- Metabolic Disorders
- Lipid Metabolism
Background:
- Severe hypertriglyceridemia (HTG) is a recognized cause of acute pancreatitis (AP), particularly in pediatric populations.
- The incidence and specific characteristics of HTG-induced AP (HTG-AP) in children are less understood compared to adults.
- Etiologies for severe HTG in children include primary genetic lipid disorders and secondary causes impacting lipid metabolism.
Purpose of the Study:
- To review the current understanding of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) in pediatric patients.
- To discuss the pathophysiology, clinical presentation, and management of HTG-AP in children.
- To highlight the need for evidence-based guidelines for pediatric HTG-AP.
Main Methods:
- Literature review of studies on pediatric HTG-AP.
- Analysis of pathophysiological mechanisms, including free fatty acid release and hyperviscosity.
- Summary of current inpatient and long-term therapeutic interventions.
Main Results:
- Triglyceride levels >1,000 mg/dL are associated with increased AP risk in adults, a threshold relevant to pediatric considerations.
- Pathophysiology involves pancreatic lipase activity and chylomicron-related hyperviscosity.
- Evidence suggests HTG-AP may present with a more severe clinical course and complications in children.
- Inpatient management includes IV fluids, insulin, and dietary changes; plasmapheresis may be needed. Long-term care involves lifestyle and medication adjustments.
Conclusions:
- Hypertriglyceridemia-induced acute pancreatitis is a significant concern in pediatric patients.
- While management strategies exist, evidence-based guidelines specifically for pediatric HTG-AP are lacking.
- Further research is needed to establish standardized treatment protocols for children with HTG-AP.
Abstract:
Severe hypertriglyceridemia (HTG) is a known metabolic cause of acute pancreatitis (AP) in pediatric patients. The incidence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is less well established in pediatric compared to adult patients. Studies in adults suggest that higher risk of AP occurs when triglyceride levels (TG) are >1,000 mg/dL. Most common etiologies for severe HTG in pediatric patients are either from primary hypertriglyceridemia, underlying genetic disorders of lipid and TG metabolism, or secondary hypertriglyceridemia, separate disease or exposure which affects TG metabolism. Most common theories for the pathophysiology of HTG-AP include hydrolysis of TG by pancreatic lipase to free fatty acids leading to endothelial and acinar cell damage and ischemia, as well as hyperviscosity related to increased chylomicrons. Though there are varying reports of HTG-AP severity compared to other causes of AP, a steadily growing body of evidence suggests that HTG-AP can be associated with more severe course and complications. Therapeutic interventions for HTG-AP typically involve inpatient management with dietary restriction, intravenous fluids, and insulin; select patients may require plasmapheresis. Long term interventions generally include dietary modification, weight management, control of secondary causes, and/or antihyperlipidemic medications. Though some therapeutic approaches and algorithms exist for adult patients, evidence-based management guidelines have not been well established for pediatric patients.
Related Concept Videos
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:17Gastritis-II: Pathophysiology
In acute gastritis, the gastric mucosa becomes swollen and red and undergoes superficial erosion. Superficial ulceration may lead to bleeding.
In chronic gastritis, persistent or repeated insults lead to chronic inflammatory changes and, eventually, thinning or atrophy of the gastric tissue.
Gastritis can stem from various causes, each...