Rapid reversal of the chylomicronaemia syndrome with conservative management.

摘要

A 31-year-old woman presented to the Emergency Department with 1 week of cramping abdominal pain and loose motions. She was evasive regarding alcohol intake, but admitted to drinking excessively for a fortnight (probable intake >100 g/day). She had a history of mild asthma, hyperlipidaemia (cholesterol 10.7 mmol/L, high-density lipoproteins 1.8 mmol/L, triglycerides 15.3 mmol/L 2 years previously) and an anxiety disorder. Her only medication was alprazolam. She had a family history of cardiovascular and cerebrovascular disease. Her father and brothers had xanthelasmas.Her body mass index was 28. Examination was unremarkable except for epigastric tenderness and guarding. At venepuncture, her blood was markedly lipaemic. Her triglyceride level was 237 mmol/L with cholesterol of 56 mmol/L. Other biochemical parameters were measured on the infranate after prolonged centrifugation at 13 000 x g. Amylase was normal at 92 U/L (normal <100 U/L), but the lipase was increased at 451 U/L (normal <60 U/L). Computed tomography of the abdomen showed peripancreatic inflammation, indicative of pancreatitis. The gall bladder appeared normal; no gallstones were detected. There was mild hepatomegaly with fatty change.Acute pancreatitis secondary to hypertriglyceridaemia/alcoholwas diagnosed. A decision was made to treat the patient conservatively. She was kept fasting, given i.v. fluids, and treated with prophylactic enoxaparin, ceftriaxoneand metronidazole with pethidine for analgesia.