Hypertriglyceridaemia Pancreatitis — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineHypertriglyceridaemia PancreatitisRACP Adult Medicine

A 45-year-old man develops acute severe pancreatitis with peripancreatic collections on CT. Serum triglycerides are 28 mmol/L. What is the specific management for hypertriglyceridaemia-induced pancreatitis?

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Correct answer: A — IV insulin infusion to lower triglycerides

Severe hypertriglyceridaemia (>11.3 mmol/L) is the third most common cause of acute pancreatitis. IV insulin infusion (with glucose to maintain euglycaemia) rapidly activates lipoprotein lipase, lowering triglyceride levels by 50% within 24–48 hours. Plasmapheresis is an alternative for refractory cases. Long-term management includes fibrate therapy (fenofibrate), dietary modification, and addressing secondary causes (diabetes, alcohol, medications). Target triglycerides <2.0 mmol/L.

Reference: eTG – 2025 – Gastrointestinal; Endocrine Society – 2012 – Hypertriglyceridaemia Guidelines