Evidence for management based on case series and reports
Insulin drip - most dramatic and rapid intervention, with reduction within 24 hrs
Initiate at 0.1 units/kg/hr (similar to treatment for DKA)
Goal is to reduce triglycerides to < 500
Add D5NS if glucose drops < 200 
Monitor BMP q2 hr
Manage potassium
K < 3.2 stop insulin and replete K
K 3.3 to 5 add 20 mEq K/Lto IVF
K > 5 no extra potassium
IVF as for standard pancreatitis treatment, add potassium as per above
Treat concurrent hypothyroidism if present
Pain control
Niacin 500mg QD
Gemfibrozil or fenofibrate
Max dose statin, 81mg ASA
Heparin q8 SC, effect short-lived
NPO initially
May advance diet starting at TG level < 1000mg/dL with resolution of abdominal pain/pancreatitis symptoms
No fat diet
Low calorie diet
Initiate at 0.1 units/kg/hr (similar to treatment for DKA)
Goal is to reduce triglycerides to < 500
Add D5NS if glucose drops < 200 
Monitor BMP q2 hr
Manage potassium
K < 3.2 stop insulin and replete K
K 3.3 to 5 add 20 mEq K/Lto IVF
K > 5 no extra potassium
K < 3.2 stop insulin and replete K
K 3.3 to 5 add 20 mEq K/Lto IVF
K > 5 no extra potassium
No fat diet
Low calorie diet
Therapeutic plasma exchange, for 1-3 days (sickest patients)
Generally indicated for hypocalcemia, persistent elevated lactic acidosis, other signs of worsening organ dysfunction
For euglycemic patients, not routine first line
Requires central venous access
Generally indicated for hypocalcemia, persistent elevated lactic acidosis, other signs of worsening organ dysfunction
Hypertriglyceridemia
Gastroesophageal reflux disease 
Polycythemia
Peptic ulcer disease with or without perforation
Lactic acidosis
Gastritis
Ketonemia
Pancreatitis