Management of hypertriglyceridemia-induced acute pancreatitis in the intensive care unit: A narrative review

PURPOSE: Severe hypertriglyceridemia causing acute pancreatitis may necessitate intensive care unit (ICU) admission. Management of hypertriglyceridemia in this setting requires therapies that result in rapid triglyceride lowering that are different from therapies used in the outpatient setting. The purpose of this narrative review is to explore strategies for managing hypertriglyceridemia-induced acute pancreatitis (HTGP) in the ICU. SUMMARY: Patients may develop acute pancreatitis when triglyceride levels exceed 500 mg/dL, either as their primary reason for admission to the ICU or as an adverse effect of medications received during ICU care. Rapid reduction of triglycerides is attained through activation of lipoprotein lipase (LPL), an enzyme essential for the removal of triglycerides from the plasma. Treatment modalities include therapeutic plasma exchange and the combination of insulin and heparin infusions for acute treatment, although there is no consensus on optimal dosing. Fibrates are recommended as first-line agents in prevention of hypertriglyceridemia-induced pancreatitis in high-risk patients. CONCLUSION: Several therapies are used for acute management of HTGP in the ICU setting. Further research is necessary to refine treatment protocols and establish best practices for managing HTGP in critically ill patients.