Hypertriglyceridemic pancreatitis associated with confounding laboratory abnormalities

Abstract

We present the case of a 36-year-old woman who presented to our hospital with epigastric abdominal pain and tenderness. Laboratory evaluation identified high lipase, normal amylase, pseudohyponatremia, and relatively falsely low triglyceride levels (initial value of 2,329 mg/dl which on repeat was found to have corrected value of !10,000 mg/dl). The overall clinical picture was consistent with acute pancreatitis due to hypertriglyceridemia. The patient was commenced on IV insulin and eventually required plasmapheresis with good clinical outcome. This case highlights the importance of being cognizant of falsely low amylase and TG levels that can be present in patients with hypertriglycereidemic pancreatitis H ypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis after alcohol and gallstones. The risk of developing acute pancreatitis is approximately 5% with triglyceride (TG) levels above 1,000 mg/dl and 10Á20% with TG levels above 2,000 mg/dl. (1). Hypertriglyceridemia-induced acute pan-creatitis (HTGP) is associated with increased severity and complications when compared with pancreatitis caused by other causes (2). Various confounding laboratory abnorm-alities can be present in patients with HTGP including falsely low TG levels and normal amylase levels. This case highlights the importance of a clinically driven decision in the diagnosis and treatment of HTGP, as early clinical recognition is important to provide appropriate treatment and to prevent further complications and recurrences.