Hyperlipidemic Abdominal Crisis: A Unique Presentation of Isolated Severe Hypertriglyceridemia

Severe hypertriglyceridemia, defined as levels >1000 mg/dL, is a condition that manifests in various ways including hyperlipidemic abdominal crisis (HLAC) with risk of progression to pancreatitis. We discuss the unique presentation of HLAC in a 50-year-old patient whose diagnosis remained unclear on initial presentation. Initial laboratory evaluation and imaging were unrevealing, but laboratory personnel relayed concerns for lipemic blood samples, prompting a lipid panel in the Emergency Department (ED). Triglycerides measured 2562 mg/dL helping to confirm probable diagnosis of HLAC. After consultation with Endocrinology, the patient was admitted for an insulin infusion with glucose-containing maintenance fluids to help treat the very severe hypertriglyceridemia. The patient was discharged in good condition on hospital day 3 with triglyceride levels down to 405 mg/dL and prescribed a new oral agent, Icosapent ethyl at 2 g orally daily. Clinicians evaluating patients for acute abdominal complaints should be alert to the possible diagnosis of HLAC given the potential for deterioration to pancreatitis and concomitant complications. Prompt management with an insulin infusion or plasmapheresis along with appropriate consultation with specialists is crucial to mitigate the risk of adverse outcomes in this rare abdominal emergency.