Hypertriglyceridemia is responsible for about ~10% of pancreatitis episodes seen in critical care. The management of this entity is highly variable, due to a lack of high-quality evidence. Approaches range from extremely aggressive (e.g. plasmapheresis) to more conservative therapy (e.g. subcutaneous insulin). This chapter attempts to unpack the physiology and evidence underlying this diagnosis, with the caveat that most questions remain without definitive answers.
-
The IBCC chapter is located 👉 here.
- The podcast & comments are below.
Follow us on iTunes
The Podcast Episode
Want to Download the Episode?
Right Click Here and Choose Save-As
- Pulmcrit wee: The cutoff razor - April 15, 2024
- PulmCrit Blogitorial – Use of ECGs for management of (sub)massive PE - March 24, 2024
- PulmCrit Wee: Propofol induced eyelid opening apraxia – the struggle is real - March 20, 2024
Thank you Josh for continuing to do what you do best – synthesizing all the literature out there and pointing out how much uncertainty there is in medicine, all the while debunking all the false dogma that has been propagated for decades! This is a true service to all of us who are incapable at looking at things with the same amount of scrutiny. I was at a resident’s morning report the other day, which happened to be on this topic and the grey beard attendings reamed the resident out for not starting an insulin drip (although the patient got… Read more »
HOLD ON a second guys… I have a hesitation with withholding fats and giving carbs to these pts. In the very recent publication American Family Physician. 2020 Sep 15;102(6):347-354 Management of Hypertriglyceridemia: Common Questions and Answers, it identifies with robust evidence just the oposite, that is, we should be restricting carbs in these pts: “Fat. Intake of any fat (monounsaturated, polyunsaturated, or saturated) lowers serum triglyceride levels.2 Increased intake of unsaturated fats can increase HDL cholesterol levels and lower triglyceride levels.24 A meta-analysis of 60 controlled trials showed that a 1% caloric decrease in carbohydrates replaced with an isocaloric increase in any type… Read more »
the stuff you’re talking about refers to *chronic* dietary considerations, not *acute* pancreatitis
Thank you so much Josh for the outstanding review. As usual, I learn more from you than by the books. I’ve been treating a patient with this problem now and we are having a hard time trying to make her calcium levels up. We used Insulin in the first two days and had a sensible clinical improvement and a significant decrease in TG level. Despite these improvements, ionised calcium levels are staying very low (0.65mg/dL – normal inferior level here = 1.05md/dL), even replacing 27.9mEq of Calcium per day via 10% Calcium Gluconate. Have you dealt with a situation as… Read more »
the best thing might be to just allow the calcium to be low. unless the patient is symptomatic, it’s probably safer to just leave it alone. so maybe start the patient on some scheduled oral calcium to keep it from going super low but then accept that the calcium will be very low?
https://emcrit.org/ibcc/hypocalcemia/#treatment