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Research Article - Anesthesiology and Clinical Science Research (2024) Volume 8, Issue 1
Acute pancreatitis by hypertriglyceridemia : Role of heparin and insulin in treatment
Acute pancreatitis is an inflammatory condition of the pancreas that is painful and at times deadly. Despite the great advances in critical care medicine over the past 20 years, the mortality rate of acute pancreatitis has remained at about 10%. The most common causes of acute pancreatitis are stones in the gallbladder and heavy alcohol consumption. There are several other causes of acute pancreatitis including, ingested medicines high triglyceride levels in the blood, infective causes, infiltrative, and neoplastic causes. Acute pancreatitis is confirmed by medical history, physical examination, and typically a blood test (amylase or lipase) for digestive enzymes of the pancreas. Blood amylase or lipase levels are typically elevated 3 times the normal level during acute pancreatitis. In some cases when the blood tests are not elevated and the diagnosis is still in question, abdominal imaging, such as a Computed Tomography (CT) scan, Magnetic Resonance Cholangiopancreatography (MRCP) might be performed. In most cases, acute pancreatitis resolves with therapy, but approximately 15% of patients develop severe disease. Severe acute pancreatitis can lead to life-threatening failure of multiple organs and to infection. Therefore, it is extremely important to seek medical attention if experiencing signs or symptoms of acute pancreatitis. Several clinical risk-scoring systems are available to help physicians predict who is most likely to develop severe acute pancreatitis. One of the primary therapies for acute pancreatitis is adequate early fluid resuscitation, especially within the first 24 hours of onset. Intravenous medications, typically potent narcotic pain medications, are effective in controlling pain associated with acute pancreatitis. Nutrition should be implemented because acute pancreatitis is a highly active state of inflammation and injury that requires a lot of calories to support the healing process. In most cases, patients can start to take in food on their own by 48 hours. In addition to providing supportive care, underlying causes need to be promptly evaluated. If the acute pancreatitis is thought to be due togallstones, medication, high triglycerides, or high calcium levels within the patient’s body (or other external causes), directed therapy can be implemented. In this case, patient had severe acute pancreatitis induced by high triglyceride levels, resultant initial respiratory depression and acute kidney insult. With establishment of supportive care in critical care setup, he was managed with specific treatment regime (heparin and insulin) as it was triglyceride induced acute pancreatitis.
Author(s): Harini Jagoda