Faculty mentor/PI email address
Antonios.Tsompanidis@hudsonregionalhealth.com
Keywords
acute pancreatitis, hypertriglyceridemia, intravenous insulin, necrotizing pancreatitis, severe pancreatitis
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Title: Acute Necrotizing Pancreatitis due to Hypertriglyceridemia: A Case Report
Background: Necrotizing pancreatitis is a severe complication of acute pancreatitis with a high risk of morbidity and mortality. Hypertriglyceridemia (HTG) is an uncommon but increasingly recognized etiology, often associated with more severe disease compared to biliary or alcoholic pancreatitis. Early recognition and targeted management are critical to prevent multiorgan failure.
Case Presentation: We present the case of a 39-year-old Hispanic male with a history of chronic hypertriglyceridemia and epilepsy who presented with acute onset of severe epigastric pain, nausea, and vomiting. Laboratory evaluation revealed markedly elevated serum triglycerides (TG) levels of 4,145 mg/dL and lipase of 40,424 U/L, consistent with HTG-induced pancreatitis. Initial abdominal computed tomography (CT) demonstrated severe acute interstitial pancreatitis, which later evolved into necrotizing pancreatitis with peripancreatic inflammation.. The patient’s hospital course was complicated by hypoxic respiratory failure, metabolic acidosis, circulatory shock and acute kidney injury, requiring intensive care management. Treatment included aggressive intravenous fluid resuscitation, insulin infusion for triglyceride reduction, electrolyte correction, and broad-spectrum antibiotics for possible secondary infection. Insulin therapy was intermittently held due to hypoglycemia but resulted in a progressive decline of TG levels from 4,145 mg/dL to 240 mg/dL over six days without the need for plasmapheresis. Total parenteral nutrition (TPN) was initiated to provide nutrition support, later transitioned to a low-fat oral diet as tolerated. The patient’s condition gradually improved with supportive and pharmacologic management. He was discharged in stable condition on fenofibrate, with recommendations for lifestyle modification, lipid monitoring, and long-term follow-up with endocrinology and gastroenterology.
Discussion: This case underscores the importance of recognizing hypertriglyceridemia as a potential cause of necrotizing pancreatitis and demonstrates that early pharmacologic management can be effective in reducing TG levels and improving outcomes. Insulin therapy plays a key role by enhancing lipoprotein lipase activity, promoting TG clearance from plasma. While plasmapheresis remains an option for refectory or extremely high TG levels, its high cost, invasiveness, and limited availability make insulin therapy a more practical first-line approach in many settings. Additionally, early nutritional support and multidisciplinary care involving intensive care, infectious disease, and gastroenterology teams are critical for preventing complications such as sepsis, organ failure, and recurrence. In summary, this case highlights that aggressive medical therapy, comprising early insulin infusion, fluid resuscitation, infection control, and nutrition management, can lead to favorable outcomes even in cases of severe HTG-induced necrotizing pancreatitis. Further research is warranted to establish standardized management protocols and identify predictors of response to insulin therapy versus plasmapheresis in patients with severe HTG pancreatitis
Disciplines
Digestive System Diseases | Medicine and Health Sciences | Nutritional and Metabolic Diseases
Acute Necrotizing Pancreatitis due to Hypertriglyceridemia: A Case Report
Title: Acute Necrotizing Pancreatitis due to Hypertriglyceridemia: A Case Report
Background: Necrotizing pancreatitis is a severe complication of acute pancreatitis with a high risk of morbidity and mortality. Hypertriglyceridemia (HTG) is an uncommon but increasingly recognized etiology, often associated with more severe disease compared to biliary or alcoholic pancreatitis. Early recognition and targeted management are critical to prevent multiorgan failure.
Case Presentation: We present the case of a 39-year-old Hispanic male with a history of chronic hypertriglyceridemia and epilepsy who presented with acute onset of severe epigastric pain, nausea, and vomiting. Laboratory evaluation revealed markedly elevated serum triglycerides (TG) levels of 4,145 mg/dL and lipase of 40,424 U/L, consistent with HTG-induced pancreatitis. Initial abdominal computed tomography (CT) demonstrated severe acute interstitial pancreatitis, which later evolved into necrotizing pancreatitis with peripancreatic inflammation.. The patient’s hospital course was complicated by hypoxic respiratory failure, metabolic acidosis, circulatory shock and acute kidney injury, requiring intensive care management. Treatment included aggressive intravenous fluid resuscitation, insulin infusion for triglyceride reduction, electrolyte correction, and broad-spectrum antibiotics for possible secondary infection. Insulin therapy was intermittently held due to hypoglycemia but resulted in a progressive decline of TG levels from 4,145 mg/dL to 240 mg/dL over six days without the need for plasmapheresis. Total parenteral nutrition (TPN) was initiated to provide nutrition support, later transitioned to a low-fat oral diet as tolerated. The patient’s condition gradually improved with supportive and pharmacologic management. He was discharged in stable condition on fenofibrate, with recommendations for lifestyle modification, lipid monitoring, and long-term follow-up with endocrinology and gastroenterology.
Discussion: This case underscores the importance of recognizing hypertriglyceridemia as a potential cause of necrotizing pancreatitis and demonstrates that early pharmacologic management can be effective in reducing TG levels and improving outcomes. Insulin therapy plays a key role by enhancing lipoprotein lipase activity, promoting TG clearance from plasma. While plasmapheresis remains an option for refectory or extremely high TG levels, its high cost, invasiveness, and limited availability make insulin therapy a more practical first-line approach in many settings. Additionally, early nutritional support and multidisciplinary care involving intensive care, infectious disease, and gastroenterology teams are critical for preventing complications such as sepsis, organ failure, and recurrence. In summary, this case highlights that aggressive medical therapy, comprising early insulin infusion, fluid resuscitation, infection control, and nutrition management, can lead to favorable outcomes even in cases of severe HTG-induced necrotizing pancreatitis. Further research is warranted to establish standardized management protocols and identify predictors of response to insulin therapy versus plasmapheresis in patients with severe HTG pancreatitis