Öz
Amaç: Bu yazıda, hipertrigliseridemik akut pankreatit (HTGAP) tanısı alan hastalarda acil servis yönetimi ile ilgili deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntem: Ekim 2015-Ekim 2016 tarihleri arasında, acil servisimize başvuran ve HTGAP tanısı alan hastaların lipaz, amilaz, trigliserid değerleri ve aldıkları tedavi rejimleri incelendi. Ortalama 1 gün/24 saat boyunca acil serviste takip edilen hastaların, klinik durumları ve başlangıç ile 24 saat sonraki trigliserid, amilaz, lipaz düzeyleri değerlendirmeye alındı. Bulgular: Çalışma süresi boyunca acil servisimize toplam 142.482 hasta başvurdu. Bu hastalardan akut pankreatit (AP) tanısı alan hasta sayısı 370’ ti. Bu hastalar içerisinde HTGAP tanılı 23-56 yaş aralığındaki 10 hastanın yaş ortalaması 36.2±19.8 olup 6' sı kadındı. Hastaların 7’ sinde hiperlipidemi, 6' sında diyabet, 2' sinde hipotroidi öyküsü vardı. Altı hasta daha önce pankreatit atağı geçirmişti. Hastaların hepsine, tanı anından itibaren acil serviste insülin infüzyon tedavisi başlandı. Ortalama 1 gün boyunca acil serviste takip edilen hastaların, klinik durumu ve 24 saat sonraki trigliserid, amilaz, lipaz düzeylerinin gerilediği görüldü. Sonuç: Acil serviste AP’ li hastalarda, etiyolojide hipertrigliseridemi akılda bulundurulmalıdır. HTGAP tanısı alan hastalarda komplikasyonları azaltmak için acil serviste erken tedavi başlanabilir ve insülin infüzyonu tedavisi, aferez tedavisine göre daha pratik ve takibi daha kolay olduğu için tüm hastalarda ilk seçenek olarak tercih edilebilir.
Anahtar Kelimeler
Acil servis hipertrigliseridemiye bağlı akut pankreatit insülin tedavisi.
Kaynakça
- Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97(9):2969-89.
- Fortson MR, Freedman SN, Webster PD. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995;90(12):2134-9.
- Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 1990;19(4):783-91.
- Yin G, Cang X, Yu G, et al. Different clinical presentations of hyperlipidemic acute pancreatitis: A retrospective study. Pancreas 2015;44(7):1105-10.
- Zheng Y, Zhou Z, Li H, et al. Multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas 2015;44(3):409-14.
- Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: Presentation and management. Am J Gastroenterol 2009;10(4):984-91.
- Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174(2):331-6.
- Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: An update. J Clin Gastroenterol 2014;48(3):195-203.
- Lloret C, Linares AL, Pelletier S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008;37(1):13-20.
- Kloer HU, Hauenschild A. Severe chylomicronemia: Clinical epidemiology and recommendations for treatment. Atheroscler Suppl 2003;4(2):234-5.
- Valdivielso P, Ramírez-Bueno A, Ewald N, et al. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014;25(8):689-94.
- Murphy MJ, Sheng X, MacDonald TM, Wei L. Hypertriglyceridemia and acute pancreatitis. JAMA Intern Med 2013;173(2):162-4.
- Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: Epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13(1):10-24.
- Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14(28):4558-61.
- Baranyai T, Terzin V, Vajda Á, et al. Hypertriglyceridemia causes more severe course of acute pancreatitis. Clin Lipidol 2012;7(6):731-6.
- Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: Presentation and management. Curr Opin Lipidol 2009;20(6):497-504.
- Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the writing committee of the American Society for Apheresis: The sixth special issue. J Clin Apher 2013;28(3):145-284.
- Jabbar MA, Zuhri-Yafi MI, Larrea J. Insulin therapy for a non-diabetic patient with severe hypertriglyceridemia. J Am Coll Nutr 1998;17(5):458-41.
- Mikhail N, Trivedi K, Page C, et al. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin. Am J Emerg Med 2005;23(3):415-7.
- Tamez-Perez HE, Saenz-Gallegos R, Hernandez-Rodriguez K, et al. Insulin therapy in patients with severe hypertriglyceridemia. Rev Med Inst Mex Seguro Soc 2006;44(3):235-7.
Öz
Aim: In this report, we aimed to share our experience on the treatment of hypertriglyceridemia induced acute pancreatitis (HTGIAP). Materials and Methods: Between October 2015-October 2016, treatment protocols and lipase, amylase and triglyceride levels of the patients who admitted to our emergency department (ED) and diagnosed as HTGIAP were included in the study. Patients’ basal and after 24 hours lipase, amylase and trigelyceride results and clinical findings were also recorded. Results: During the study period, 142.482 patients were admitted to our emergency department. Of this overall number, 370 patients were diagnosed as acute pancreatitis (AP). Among these patients, the mean age of 10 patients who were diagnosed with HTGAP was 36.2±19.8 and six of them were female. Seven of these patients had a history of hyperlipidemia, 6 had diabetes mellitus, 2 had hypothyroidism and 6 patients had a prior acute pancreatitis attack. In ED, after the diagnosis of HTGIAP, insulin infusion treatment was started to all the patients. Average follow-up time in the ED is about one day and after 24 hours, severity of clinical signs were regressed and levels of triglyceride, amylase, and lipase were decreased in all patients. Conclusion: Emergency physicians should kept hypertriglyceridemia in mind in differential diagnosis of acute pancreatitis. To reduce the complication rate in patients who diagnosed as HTGIAP in the ED, early treatment protocol should be applied. Insulin infusion treatment may be preferred as first choice in these cases, because it is more practical and is easier to follow than apheresis treatment in the ED conditions.
Anahtar Kelimeler
Emergency department hypertriglyceridemia induced acute pancreatitis insulin therapy.
Kaynakça
- Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97(9):2969-89.
- Fortson MR, Freedman SN, Webster PD. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 1995;90(12):2134-9.
- Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 1990;19(4):783-91.
- Yin G, Cang X, Yu G, et al. Different clinical presentations of hyperlipidemic acute pancreatitis: A retrospective study. Pancreas 2015;44(7):1105-10.
- Zheng Y, Zhou Z, Li H, et al. Multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas 2015;44(3):409-14.
- Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: Presentation and management. Am J Gastroenterol 2009;10(4):984-91.
- Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174(2):331-6.
- Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: An update. J Clin Gastroenterol 2014;48(3):195-203.
- Lloret C, Linares AL, Pelletier S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008;37(1):13-20.
- Kloer HU, Hauenschild A. Severe chylomicronemia: Clinical epidemiology and recommendations for treatment. Atheroscler Suppl 2003;4(2):234-5.
- Valdivielso P, Ramírez-Bueno A, Ewald N, et al. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014;25(8):689-94.
- Murphy MJ, Sheng X, MacDonald TM, Wei L. Hypertriglyceridemia and acute pancreatitis. JAMA Intern Med 2013;173(2):162-4.
- Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: Epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13(1):10-24.
- Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14(28):4558-61.
- Baranyai T, Terzin V, Vajda Á, et al. Hypertriglyceridemia causes more severe course of acute pancreatitis. Clin Lipidol 2012;7(6):731-6.
- Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: Presentation and management. Curr Opin Lipidol 2009;20(6):497-504.
- Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the writing committee of the American Society for Apheresis: The sixth special issue. J Clin Apher 2013;28(3):145-284.
- Jabbar MA, Zuhri-Yafi MI, Larrea J. Insulin therapy for a non-diabetic patient with severe hypertriglyceridemia. J Am Coll Nutr 1998;17(5):458-41.
- Mikhail N, Trivedi K, Page C, et al. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin. Am J Emerg Med 2005;23(3):415-7.
- Tamez-Perez HE, Saenz-Gallegos R, Hernandez-Rodriguez K, et al. Insulin therapy in patients with severe hypertriglyceridemia. Rev Med Inst Mex Seguro Soc 2006;44(3):235-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Haziran 2019 |
| Gönderilme Tarihi | 22 Şubat 2018 |
| Yayımlandığı Sayı | Yıl 2019 |