Hypertriglyceridemia-Induced Acute Pancreatitis: Management with only Insulin

Background: Hypertriglyceridemia (HTG) is the third leading cause of acute pancreatitis, responsible for up to 10% of cases. HTG pancreatitis is often more severe and complicated, with clinical presentation and diagnosis like other forms of acute pancreatitis. Management involves treating acute pancreatitis and reducing serum triglyceride (TG) levels below 500 mg/dl to prevent necrotizing pancreatitis. While plasmapheresis and other rapid reduction techniques exist, they are costly and less accessible in Africa. Insulin infusion, alone or with heparin, has shown potential in case studies for lowering TG, yet evidence is limited, with only one publication on their combined use. No studies have been published in Africa on using insulin alone for HTGP treatment. Case report: We report a case of a 30-year-old Ethiopian male smoker and alcoholic, who presented to the emergency department with severe epigastric pain, nausea, and vomiting for one day. He was tachycardic, obese, and had a tender, distended abdomen. Laboratory tests revealed a serum TG level of 2205 mg/dL. An abdominal CT scan showed diffuse pancreatic swelling and minimal peripancreatic fluid. Diagnosed with HTG pancreatitis, he was treated with intravenous insulin alone, and he was discharged without complications. Conclusion: Our findings, based on case-control trials and case reports, support the safety and efficacy of insulin therapy for HTG pancreatitis. In resource-limited countries like Africa, insulin is more accessible than treatments like plasmapheresis, helping to prevent complications. This report aims to enhance physicians’ understanding of insulin management and encourage further research in this area.