Pancreatitis from high triglycerides

Pancreatitis from high triglycerides is a special kind of pancreatitis, and it needs a different treatment than regular pancreatitis. In the last 15 years, I have taken care of several patients with acute pancreatitis from high triglycerides. I am writing this article based on my personal experience as well as a thorough review of relevant medical journals.

In this article, we will learn:

  1. What triglyceride level causes pancreatitis
  2. How high triglycerides cause pancreatitis
  3. Symptoms of pancreatitis from high triglycerides
  4. What to expect when hospitalized with pancreatitis from high triglycerides

What level of triglycerides causes pancreatitis?

High triglycerides in the blood is a very common problem. However, the level of triglycerides that causes pancreatitis is several times higher than what is usually considered high.

Before we go into triglyceride levels, let’s explore what triglycerides are. Simply speaking, triglycerides are just fats. They are similar to fats in food such as butter, lard, or vegetable oil. In addition to triglycerides absorbed from food, your body also makes them from carbohydrates.

Triglycerides are usually packaged with cholesterol by using certain proteins made by the liver. This packaging makes otherwise insoluble fats dissolve in blood. Triglyceride levels are usually measured as part of blood cholesterol tests called a lipid panel.

Blood triglyceride levels above 150 mg/dl are considered high. High triglyceride levels usually don’t cause pancreatitis until they get to 1000 mg/dl. About 5% of people with triglycerides higher than 1000 mg/dl get acute pancreatitis. When triglycerides are higher than 2000 mg/dl, about 20% of people get acute pancreatitis.

When triglyceride levels are very high, your blood becomes almost milky in color due to a high fat content.

How do triglycerides cause pancreatitis?

The product of fats breaking down, called free fatty acids, are thought to be very toxic to the pancreas, which makes digestive juices. These digestive juices break down fats, proteins, and carbohydrates in your food. Inside the pancreas, fats get broken down into fatty acid. Fatty acid damages the pancreas, and digestive enzymes leak out. These corrosive enzymes cause inflammation of the surrounding tissue, and you get severe pain associated with acute pancreatitis.

A diagram showing a normal pancreas and an inflamed pancreas and how a normal pancreas can become inflamed.
A diagram showing a normal pancreas and an inflamed pancreas

What are the symptoms of pancreatitis from high triglycerides?

Symptoms of pancreatitis from high triglycerides are usually similar to but more severe than symptoms of pancreatitis from other causes. The higher the triglyceride levels, the more severe the symptoms.

Here are 3 common symptoms:

  1. Abdominal pain
  2. Nausea
  3. Vomiting

Abdominal pain from pancreatitis due to high triglycerides is usually felt in the mid-upper belly. The pain is sudden and worsens quickly. It spreads out in both directions like a thick belt. Pain may also radiate to your back. You usually have nausea and vomiting with the pain.

What to expect when hospitalized with pancreatitis from high triglycerides

When you visit the ER with abdominal pain, the level of lipase in your blood will alert the doctor about the possibility of acute pancreatitis. This blood test is done in most patients who visit the ER with abdominal pain. Lipase is one of the enzymes made by the pancreas. A high lipase blood level means that the pancreas is damaged, and enzymes are spilling out into the blood. The higher the level of lipase, the worse the pancreatitis.

When there are no other obvious signs of pancreatitis, your doctor will order a lipid panel. If your lipid panel shows triglyceride levels of more than 1000mg/dl, you will be diagnosed with pancreatitis from high cholesterol.

Once diagnosed, you can expect the following treatment in the hospital:

  1. No food or water: It is important to withhold all food and water at first. Any food or water may trigger your pancreas to make more enzymes that can worsen the inflammation.
  2. IV fluids: You will get IV fluids to replace water and electrolytes in your body.
  3. Pain medications: Pancreatitits from high triglycerides can be very painful. You will get IV pain medications to help.
  4. Anti-nausea medications: Nausea is a cause of major distress with pancreatitis. Anti-nausea medications help you feel better.
  5. Plasmapheresis: This is the specific treatment for pancreatitis with high cholesterol. Your blood is taken out of your body and passed through a machine. The machine separates your blood cells from the liquid part of your blood, called plasma. Blood cells are transfused back into your body, and plasma containing dissolved triglycerides is discarded. Plasma is replaced by fresh blood without dissolved fat. Blood is continuously circulated until all of your blood passes through the machine. Your triglyceride levels will start dropping, meaning your pancreas can now rest to repair itself. This process is continued until your triglyceride level drops to 500 mg/dl.
  6. Insulin: Insulin is used to lower your triglycerides when the machine for plasmapheresis is not available, or when plasmapheresis can’t be done for some other reason. You don’t need to have diabetes to get this treatment. Insulin makes triglycerides in your blood go inside your fat cells and get stored as body fat. Your triglyceride levels drop slowly, giving your pancreas some relief. Insulin also lowers blood sugars. You may need a glucose infusion along with insulin to make sure your glucose levels don’t drop too fast.

As your pain improves, you can start to think about going home. You need to meet this criteria to be able to go home after being hospitalized with pancreatitis from high triglycerides:

  1. Your pain is tolerable.
  2. Your triglycerides levels stay below 500 mg/dl.
  3. You are able to eat and drink enough to sustain yourself without IV fluids.
  4. You are not vomiting repeatedly

In conclusion, high triglyceride levels can cause severe pancreatitis. Pancreatitis from high triglycerides may need a special treatment called plasmapheresis. Controlling pain and nausea are very important while treating pancreatitis.