An Uncommon Cause of Chest Pain: Hypertriglyceridemia-Induced Pancreatitis.
Brian J Fasolka, Leon L Chen
PMID 31789874WHAT IT FOUND
Potassium and liver function tests were not reported after initial and repeat samples because the blood was lipemic.
Triglycerides were 2930 mg/dL, and lipase was 498 units/L. The patient had hypertriglyceridemia-induced pancreatitis.
Key findings
01The patient's potassium and liver function tests were not reported after initial and repeat samples because the sample was lipemic, and lipase 498 units/L with triglyceride 2930 mg/dL identified hypertriglyceridemia-induced pancreatitis.
02The ED course included aspirin, nitroglycerin, IV morphine, Lactated Ringer's, ondansetron, insulin infusion, and monitoring with blood pressure checks every 30 minutes; pain was rated 10/10 on a 0 to 10 scale initially, 9/10 after 3 nitroglycerin doses, and 3/10 after IV morphine, and the paper does not separate the contribution of any single component.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report, so it cannot show that any treatment worked or that this cause is common. The patient's MICU course and long-term outcome are not reported. The cause of the severe hypertriglyceridemia is not established. The authors state that insulin infusion and plasmapheresis lack large randomized studies and are supported mainly by small retrospective studies, case reports, and case series. Persistent lipemia delayed reporting of some laboratory values.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that insulin infusion or morphine reliably treats hypertriglyceridemia-induced pancreatitis. It describes a single patient, and the patient received aspirin, nitroglycerin, morphine, Lactated Ringer's, ondansetron, insulin infusion, and monitoring in the same ED course. The paper also states that supporting data are mainly small retrospective studies, case reports, and case series.