Severe hyperlipidemia may precipitate episodes of acute pancreatitis. Future episodes of acute pancreatitis can be prevented by aggressive management of the underlying lipid disorder and any secondary factors.


Conditions associated with hyperlipidemic pancreatitis:

(1) hereditary/familial hyperlipidemia types I, IV or V (Fredrickson's classification)

(2) hyperlipidemia with an acute increase from an acquired/secondary cause


Secondary causes for an acute rise in triglycerides:

(1) ethanol abuse

(2) obesity

(3) diabetes mellitus

(4) pregnancy

(5) hypothyroidism

(6) chronic renal failure

(7) parenteral lipid or propofol infusion

(8) medications (thiazides, tamoxifen, exogenous estrogen including oral contraceptives, beta blockers, protease inhibitors)


Laboratory findings:

(1) increased chylomicrons and/or VLDL

(2) serum triglycerides > 1,000 mg/dL

(3) milky (lactescent) serum

(4) amylase and lipase levels are variable, ranging from normal to elevated


NOTE: Marked elevation in serum cholesterol will not cause pancreatitis.


Management is directed to keep serum triglyceride levels below 1,000 mg/dL:

(1) dietary restriction of fat

(2) lipid lowering medications

(3) if secondary, avoidance of precipitating factors


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