Bethzatha General Hospital, P.O. Box 57060, Addis Ababa, Ethiopia.
College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
J Med Case Rep. 2023 Jun 20;17(1):256. doi: 10.1186/s13256-023-03995-x.
Alcohol and gall stones are common causes of pancreatitis. Other causes of pancreatitis include hypertriglyceridemia, trauma, congenital anomalies, and medications. Hypertriglyceridemic pancreatitis is distinguished, as it is more severe and complicated. The management of hypertriglyceridemic pancreatitis, other than the basic care given to other pancreatitis patients, is to decrease the serum triglyceride level to less than 500 mg/dl as soon as possible. Plasmapheresis, hemofiltration, and other modalities have been proven effective therapies, but, are expensive and not easily accessible. Insulin and heparin which are cheaper alternatives for treatment, have been reported in case reports along with one randomized controlled trial. The number of patients in these reports was small, so, the therapy is not well established. For most African countries like ours, the only option for management is heparin and insulin. Despite this fact, there has not been any publication regarding this issue on our continent.
We report the case of a 24 years old Ethiopian male who presented with severe central abdominal pain, easy fatiguability, and vomiting of one-day duration. He was tachycardic and tachypneic with diffuse abdominal tenderness, and had tendon xanthomas. His plasma was lactescent with a serum triglyceride level of 4775 mg/dl. His abdominal CT scan showed diffuse pancreatic swelling with a peripancreatic fluid collection, and his serum lipase was elevated. With a diagnosis of hypertriglyceridemic pancreatitis, he was managed with intravenous insulin infusion along with subcutaneous heparin. His random blood sugar was checked hourly with three episodes of hypoglycemia during therapy. His serum triglyceride level dropped to less than 500 mg/dl in three days, and he was discharged with no complications.
Since our findings are consistent with a prior randomized controlled trial and compilation of case reports, it would strengthen the evidence for safety and efficacy of insulin and heparin therapy. This therapy, which is the only available therapy in most countries of our continent, would decrease most of the complications of hypertriglyceridemic pancreatitis that we face. We believe, our report would be a wake-up call for researchers and clinicians in our continent to change their practice and strengthen the evidence for the treatment.
酒精和胆石症是胰腺炎的常见病因。胰腺炎的其他病因包括高甘油三酯血症、创伤、先天异常和药物。高甘油三酯血症性胰腺炎的特点是更为严重和复杂。除了给予其他胰腺炎患者的基本护理外，高甘油三酯血症性胰腺炎的治疗方法是尽快将血清甘油三酯水平降至 500mg/dl 以下。血浆置换、血液滤过和其他方法已被证明是有效的治疗方法，但费用昂贵且不易获得。胰岛素和肝素作为更便宜的替代治疗方法，已在病例报告以及一项随机对照试验中得到报道。这些报告中的患者数量较少，因此治疗方法尚未得到很好的确立。对于我们这样的大多数非洲国家，管理的唯一选择是肝素和胰岛素。尽管如此，我们大陆上尚未对此问题发表任何出版物。
我们报告了一名 24 岁埃塞俄比亚男性的病例，他因剧烈的中央腹痛、易疲劳和一天呕吐而就诊。他心动过速和呼吸急促，全腹压痛，并有腱黄瘤。他的血浆呈乳白色，血清甘油三酯水平为 4775mg/dl。他的腹部 CT 扫描显示弥漫性胰腺肿胀伴胰周液体积聚，血清脂肪酶升高。诊断为高甘油三酯血症性胰腺炎，给予静脉胰岛素输注和皮下肝素治疗。他的随机血糖每小时检查一次，治疗期间发生了三次数值过低的低血糖症。他的血清甘油三酯水平在三天内降至 500mg/dl 以下，无并发症出院。
由于我们的发现与之前的一项随机对照试验和病例报告汇编一致，因此这将加强胰岛素和肝素治疗的安全性和有效性证据。这种治疗方法是我们大陆大多数国家唯一可用的治疗方法，将降低我们面临的大多数高甘油三酯血症性胰腺炎并发症。我们相信，我们的报告将为我们大陆的研究人员和临床医生敲响警钟，促使他们改变实践并为治疗提供更有力的证据。
