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Complicated Treatment Course of Severe Asymptomatic Hypertriglyceridemia: A Case Report and Literature Review
Ahmad Wasfi Haddad1, Mohammad N Kloub1, Wassim Abouzeid1
1Department of Internal Medicine, Saint Michael's Medical Center, Newark, NJ, USA.
Insights
Managing severe hypertriglyceridemia (HTG) with statins and fibrates can cause liver injury. This case shows the need for careful monitoring and alternative treatments for HTG when liver complications arise.
Area of Science:
- Cardiology
- Hepatology
- Endocrinology
Background:
- Severe hypertriglyceridemia (HTG) is often managed with lifestyle changes, statins, and fibrates.
- Concurrent use of statins and fibrates poses a risk of medication-induced liver injury.
- Asymptomatic severe HTG requires careful management to prevent complications.
Approach:
- A case report of a 43-year-old male with severe HTG (>11,370 mg/dL) initially treated with high-intensity statins and fibrates.
- The patient developed acute liver injury due to the combined medication, necessitating cessation of oral drugs and hospital admission.
- Treatment involved an insulin drip, initially resistant, requiring dose escalation, followed by discharge on fenofibrate and subcutaneous insulin.
Key Points:
- Concurrent statin-fibrate therapy led to acute liver injury in a patient with severe asymptomatic HTG.
- Triglyceride levels were resistant to standard insulin therapy, requiring higher doses.
- Management shifted to fenofibrate and insulin, with subsequent discontinuation of fibrate and reliance on statins and lifestyle modifications.
Conclusions:
- This case underscores the importance of heightened awareness and collaborative efforts in managing severe asymptomatic HTG, especially when liver injury occurs.
- Further research is needed on managing severe asymptomatic HTG in patients experiencing liver injury.
- This report contributes valuable insights into the complex management of rare HTG cases complicated by acute liver injury.
Abstract:
BACKGROUND Close observation, statins, fibrate treatment, and lifestyle changes can safely manage asymptomatic individuals with severe hypertriglyceridemia (HTG) and minimal risk of symptom development. However, the risk of medication-induced liver injury in patients taking statin-fibrate makes management more challenging, and may require hospital admission and close monitoring with follow-up. CASE REPORT We present a rare case of a 43-year-old man with asymptomatic severe HTG exceeding 11.370 mg/dL with mixed hyperlipidemia, managed initially with high-intensity statins and fibrate. However, due to the concurrent use of statin and fibrates, the patient subsequently developed an acute liver injury. Hence, the oral medications had to be stopped, and the patient was admitted to the hospital for an insulin drip. Even during the hospital course, the patient's triglyceride (TG) levels showed resistance to the recommended dose of insulin and he required a higher insulin dose. He was discharged on fenofibrate and subcutaneous insulin to keep the TG level under 500. Fibrate was stopped, and high-intensity statin was used as primary prevention with lifestyle modifications. CONCLUSIONS This instance highlights the necessity of increased cognizance and cooperative endeavors in handling severe asymptomatic HTG. Our results highlight the significance of further research into the management of severe asymptomatic HTG in cases of injury to the liver. This work adds essential knowledge to the ongoing discussion about managing a rare case complicated by acute liver injury.
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