Abstract
Abstract:Triglyceride levels greater than 1,000 mg/dL may cause severe pancreatitis, and there is mounting evidence for the use of plasmapheresis to remove triglycerides for the treatment of triglyceride-induced pancreatitis. The failure of continuous venovenous hemodialysis (CVVHD) due to severe lipemia, necessitating plasmapheresis in the early phase of severe acute hypertriglyceridemia-induced pancreatitis, is reported. We suggest that in the setting of hypertriglyceridemia-induced pancreatitis with urgent indication for dialysis, plasmapheresis be initiated prior to CVVHD to prevent rheologic failure.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References1. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med 2006;354:2142–2150.WhitcombDCClinical practice. Acute pancreatitis.N Engl J Med20063542142-21502. Baron TH, Morgan DE. Acute necrotizing pancreatitis. N Engl J Med 1999;340:1412–1417.BaronTH]]MorganDEAcute necrotizing pancreatitis.N Engl J Med19993401412-14173. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 2003;36:54–62.YadavD]]PitchumoniCSIssues in hyperlipidemic pancreatitis.J Clin Gastroenterol20033654-624. Werner J, Feuerbach S, Uhl W, et al. Management of acute pancreatitis: from surgery to interventional intesive care. Gut 2005;54:426–436.WernerJ]]FeuerbachS]]UhlW&etal;Management of acute pancreatitis: from surgery to interventional intesive care.Gut200554426-4365. Brunzell JD. Clinical practice. Hypertriglyceridemia. N Engl J Med 2007;357:1009–1017.BrunzellJDClinical practice. Hypertriglyceridemia.N Engl J Med20073571009-10176. Ferns G, Keti V, Griffin B. Investigation and management of hypertriglyceridaemia. J Clin Pathol 2008;61:1174–1183.FernsG]]KetiV]]GriffinBInvestigation and management of hypertriglyceridaemia.J Clin Pathol2008611174-11837. Lloret Linares CL, Pelletier AL, Czernichow S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglycerideima. Pancreas 2008;37:13–18.Lloret LinaresCL]]PelletierAL]]CzernichowS&etal;Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglycerideima.Pancreas20083713-188. Athyros VG, Giouleme OI, Nikolaidis NL, et al. Long term follow up of patients with acute hypertriglyceridemia induced pancreatitis. J Clin Gastroenterol 2002;34:472–475.AthyrosVG]]GioulemeOI]]NikolaidisNL&etal;Long term follow up of patients with acute hypertriglyceridemia induced pancreatitis.J Clin Gastroenterol200234472-4759. Giannini G, Valbonesi M, Morelli F, et al. Hypertriglyceridemia: apheretic treatment. Int J Artif Organs 2005;28:1018–1024.GianniniG]]ValbonesiM]]MorelliF&etal;Hypertriglyceridemia: apheretic treatment.Int J Artif Organs2005281018-102410. Alagözlü H, Cindoruk M, Karakan T, et al. Heparin and insulin in the treatment of hypertriglyceridemia-induced severe acute pancreatitis. Dig Dis Sci 2006;51:931–933.AlagözlüH]]CindorukM]]KarakanT&etal;Heparin and insulin in the treatment of hypertriglyceridemia-induced severe acute pancreatitis.Dig Dis Sci200651931-93311. Stegmayr BG, Banga R, Berggren L, et al. Plasma exchange as rescue therapy in multiple organ failure including acute renal failure. Crit Care Med 2003;31:1730–1736.StegmayrBG]]BangaR]]BerggrenL&etal;Plasma exchange as rescue therapy in multiple organ failure including acute renal failure.Crit Care Med2003311730-173612. Piolot A, Nadler F, Cavallero E, et al. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas 1996;13:96–99.PiolotA]]NadlerF]]CavalleroE&etal;Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis.Pancreas19961396-9913. Iskandar SB, Olive KE. Plasmapheresis as an adjuvant therapy for hypertriglyceridemia-induced pancreatitis. Am J Med Sci 2004;328:290–294.IskandarSB]]OliveKEPlasmapheresis as an adjuvant therapy for hypertriglyceridemia-induced pancreatitis.Am J Med Sci2004328290-29414. Chen JH, Yeh JH, Lai HW, et al. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272–2274.ChenJH]]YehJH]]LaiHW&etal;Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis.World J Gastroenterol2004102272-227415. Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study. Transfus Apher Sci 2006;34:253–257.KadikoyluG]]YavasogluI]]BolamanZPlasma exchange in severe hypertriglyceridemia a clinical study.Transfus Apher Sci200634253-25716. VA/NIH Acute Renal Failure Trial Network; Palevsky PM, Zhang JH, O’Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7–20.VA/NIH Acute Renal Failure Trial NetworkPalevskyPM]]ZhangJH]]O’ConnorTZ&etal;Intensity of renal support in critically ill patients with acute kidney injury.N Engl J Med20083597-2017. Yekebas EF, Eisenberger CF, Ohnesorge H, et al. Attenuation of sepsis-related immunoparalysis by continuous veno-venous hemofiltration in experimental porcine pancreatitis. Crit Care Med 2001;29:1423–1430.YekebasEF]]EisenbergerCF]]OhnesorgeH&etal;Attenuation of sepsis-related immunoparalysis by continuous veno-venous hemofiltration in experimental porcine pancreatitis.Crit Care Med2001291423-143018. Li W, Yan X, Wang H, et al. Effects of continuous high-volume hemofiltration on experimental severe acute pancreatitis in pigs. Pancreas 2007;34:112–119.LiW]]YanX]]WangH&etal;Effects of continuous high-volume hemofiltration on experimental severe acute pancreatitis in pigs.Pancreas200734112-11919. Pupelis G, Plaudis H, Grigane A, et al. Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience. HPB (Oxford) 2007;9:295–301.PupelisG]]PlaudisH]]GriganeA&etal;Continuous veno-venous haemofiltration in the treatment of severe acute pancreatitis: 6-year experience.HPB (Oxford)20079295-30120. Jiang HL, Xue WJ, Li DQ, et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol 2005;11:4815–4821.JiangHL]]XueWJ]]LiDQ&etal;Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis.World J Gastroenterol2005114815-482121. Mayer J, Rau B, Gansauge F, et al. Inflammatory mediators in human acute pancreatitis: clinical and patholphysiological implications. Gut 2000;47:546–552.MayerJ]]RauB]]GansaugeF&etal;Inflammatory mediators in human acute pancreatitis: clinical and patholphysiological implications.Gut200047546-55222. Dechmann-Sültemeyer T, Linkeschova R, Lenzen K, et al. Tandem plasmapheresis and haemodialysis as a safe procedure in 82 patients with immune-mediated disease. Nephrol Dial Transplant 2009;24:252–257.Dechmann-SültemeyerT]]LinkeschovaR]]LenzenK&etal;Tandem plasmapheresis and haemodialysis as a safe procedure in 82 patients with immune-mediated disease.Nephrol Dial Transplant200924252-25723. Nakae H, Igarashi T, Tajimi K, et al. A case report of hepatorenal syndrome treated with plasma diafiltration (selective plasma filtration with dialysis). Ther Apher Dial 2007;11:391–395.NakaeH]]IgarashiT]]TajimiK&etal;A case report of hepatorenal syndrome treated with plasma diafiltration (selective plasma filtration with dialysis).Ther Apher Dial200711391-395
