Introduction
obesity, alcoholism, primary disorder, gall stones, inflammation, congenital anomalies, lactescent, HTGP, diabetes, HTG, hypertriglyceridemia, TG, trauma
ACUTE PANCREATITIS, OBESITY, HYPERLIPOPROTEINEMIA, INFLAMMATION, HYPERTRIGLYCERIDEMIA, ACUTE PANCREATITIS, HYPERTRIGLYCERIDEMIA, PRIMARY DISORDERS, DIABETES
Acute pancreatitis (AP) is inflammatory damage to the pancreas. It causes a set of clinical symptoms and signs, with serum amylase levels being elevated three times the upper limit of normal, and imaging that shows evidence of inflammation in the pancreas. The global incidence of acute pancreatitis has been estimated to be 33.74 per 100,000 population, while its mortality has been estimated to be 1.16 per 100,000 population [The most common causes of acute pancreatitis are gall stones and alcohol. While other less common causes include hypertriglyceridemia (HTG), trauma, medications, and congenital anomalies [Hypertriglyceridemia can occur either as a primary disorder (type I, IV, and V hyperlipoproteinemia), or following alcoholism, diabetes, pregnancy, obesity, and the use of some drugs. Seventy-five percent of hypertriglyceridemic patients, either have uncontrolled diabetes or are alcoholics [A serum TG level above 1000 mg/dl increases the risk of AP to 16–20%. The risk increases even further by 4%, for every 100 mg/dl rise in serum TG level above 1000 mg/dl. In patients with AP, the presence of a lactescent serum is strongly correlated with HTGP [The management of HTGP includes; keeping patients fasted, analgesics, and fluid resuscitation along with treatments targeted to acutely decrease the serum TG level below 500 mg/dl. To attain these goals, plasmapheresis, insulin infusion, heparin, fibrate therapy, and apolipoprotein C-II derivatives have been used [The use of insulin alone or in combination with heparin, even though cheap and easily accessible, has not been definitively established in the management of HTGP. Heparin and insulin enhance the activity of lipoprotein lipase and increase its release from the endothelium, aiding in the lowering of serum TG levels. In all cases, insulin is used as an infusion while heparin is administered subcutaneous (SC) or intravenous (IV) at varying doses. Both unfractionated and low molecular weight heparin has been used in the literature, and both seem to have equal efficacy [One randomized controlled trial and some case series have shown the safety and efficacy of heparin and insulin in the management of HTGP. To the author's knowledge 56 cases of HTGP managed with insulin and heparin have been reported so far, 22 from case compilations and 34 from a randomized controlled trial reported from China. There has been no publication regarding the use of insulin and heparin from the African continent, where all the other management modalities are either expensive or not available. This report specifically hopes to show that a cheap, effective, and safe therapy for HTGP is available, and can be used in the African continent.