Symptoms to Diagnosis

Acute pancreatitis secondary to hypertriglyceridemia

Michael A. Munoz, MD, Kaviya Sathyakumar, MD and Benson A. Babu, MD, MBA
Cleveland Clinic Journal of Medicine December 2020, 87 (12) 742-750; DOI: https://doi.org/10.3949/ccjm.87a.19156

Article Figures & Data

Tables

  • TABLE 1

    Diagnostic criteria for acute pancreatitis

    Must have at least 2 of these 3 criteria:
    Abdominal pain
    Serum amylase or lipase level at least 3 times the upper limit of normal
    Ultrasonography, computed tomography, or magnetic resonance imaging that shows irritation of the pancreas

    • Based on information in reference 8.

  • TABLE 2

    Bedside Index of Severity in Acute Pancreatitis

    Clinical factorScore
    Yes = 1 point
    No = 0 points
    Blood urea nitrogen > 25 mg/dL
    Abnormal mental status (Glasgow Coma Score < 15)
    Evidence of systemic inflammatory response
    syndromea
    Over age 60
    Imaging tests showing pleural effusion
    Total pointsb

    • ↵a Requires at least 2 of the following: temperature < 36°C or > 38°C, respiratory rate > 20 breaths per minute or PaCO2 < 32 mm Hg, pulse > 90 beats per minute, and white blood cell count < 2.0 or > 12.0 × 109/L or > 10% immature bands.

    • ↵b 0–2 points = low mortality risk (< 2%); ≥ 3 points = high mortality risk (> 15%).

    • Repinted from Hagjer S, Kumar N. Evaluation of the BISAP scoring system in prognostication of acute pancreatitis—A prospective observational study. Int J Surg 2018; 54(Pt A):76–81 doi:10.1016/j.ijsu.2018.04.026 with permission from Elsevier. https://www.journals.elsevier.com/international-journal-of-surgery

  • TABLE 3

    Revised Atlanta classification of severity of acute pancreatitis

    MildModerate to severeSevere
    Absence of organ failureOrgan failure for < 48 hoursPersistent organ failure for > 48 hours
    Absence of local complicationsaLocal complicationsa

    • ↵a Local complications: interstitial edematous pancreatitis, necrotizing pancreatitis, pancreatic pseudocyst, necrotic collection, and pleural effusion.

    • Based on information in references 8 and 14.

  • TABLE 4

    Modified Marshall scoring system for organ failure

    RespiratoryRenalCardiovascular
    ScoreaPaO2/FiO2bSerum creatinine (mg/dL)Systolic blood pressure (mm Hg)
    0> 400≤ 1.4> 90
    1301–4001.5–1.8< 90 and responding to fluid resuscitation
    2201–3001.9–3.5< 90 and not responding to fluid resuscitation
    3101–2003.6–4.9< 90 with pH < 7.3
    4≤ 100≥ 5< 90 with pH < 7.2

    • ↵a A score of 2 or more indicates organ failure. Persistent failure is considered organ failure lasting longer than 48 hours.

    • ↵b Ratio of partial pressure of arterial oxygen to fractional inspired oxygen.

    • Based on information in references 8 and 14.

  • TABLE 5

    Criteria for clinical diagnosis of hypertriglyceridemia

    Degree of hypertriglyceridemiaSerum triglycerides (mg/dL)
    Mild150–199
    Moderate200–999
    Severe1,000–1,999
    Very severe≥ 2,000

    • Based on Endocrine Society clinical practice guidelines, reference 18.

  • TABLE 6

    Causes of hypertriglyceridemia

    Primary causes
    Familial hypertriglyceridemia
    Apolipoprotein C-II deficiency
    Familial combined hyperlipidemia
    Secondary causes (acquired)
    Diseases
    Hypothyroidism
    Diabetes mellitus
    Renal disease
    Human immunodeficiency virus-associated dyslipidemia
    Systemic lupus erythematosus
    Nephrotic syndrome
    Pregnancy
    Medications
    Beta-blockers
    Corticosteroids
    Thiazides
    Protease inhibitors
    Second-generation antipsychotics
    Estrogen-based oral contraceptives
    Diet
    Excessive alcohol intake
    High-fat diet

    • Based on information in reference 16.

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