Triglyeride-induced Pancreatitis: Diagnostic and Therapeutic Approach

Abstract

Hyper triglyceride-induced pancreatitis is rarely associated with triglyceride levels less than 1000 mg/dl. However, triglyceride levels can drop rapidly with fasting that often accompanies acute pancreatitis. In addition, triglyceride levels can be elevated in the setting of acute pancreatitis as injury to the pancreas causes inadequate lipid metabolism leading to triglyceride elevation. Thus, the question arises whether elevated triglycerides induce acute pancreatitis or vice versa in patients presenting with elevated triglyceride levels. Also, the drop in triglyceride levels associated with fasting may result in failure to consider hyper triglyceridemia as the etiology for acute pancreatitis in a patient who presents with triglyceride levels below 1000 mg/dL. In this review, we discuss the relationship between hyper triglyceridemia and pancreatitis as well as causes of elevated triglyceride levels that must be considered in patients who present with both conditions. In addition, we present an evidence based algorithm that summarizes the approach to hyper triglyceridemia and pancreatitis in the setting of complex medical co-morbidities.