UMEM Educational Pearls

Category: Visual Diagnosis

Title: Visual Dx (Courtesy of Maite Huis in 't Veld)

Posted: 10/5/2018 by Michael Bond, MD (Emailed: 12/7/2019) (Updated: 12/7/2019)
Click here to contact Michael Bond, MD

Question

33 y/o M with PMH of ETOH induced pancreatitis presents with epigastic/RUQ pain & N/V after drinking last night, per patient his usual “pancreas pain”. The nurse shows you his blood tubes because they look “milky”. Lipase 1200, Ca 6.8.

 



What lab test would you add?

 

Answer

Answer: triglyceride level.

This patient has hypertriglyceridemia induced acure pancreatitis. His triglyceride level was 3047 mg/dL (normal value <150), HDL 20 mg/dL (normal value 40-60), total cholesterol 276 mg/dL (normal <200). 

Treatment includes starting the patient on insulin drip, as insulin decreases serum triglyceride levels. If the glucose is <200 mg/dL the patient needs to started on dextrose 5% infusion. Apheresis can be considered if the patients triglyceride levels do not come down with insulin infusion (normally down without 3-4 days). Goal is a triglyceride level <500.