Undetectable triglycerides related to the combined intake of ascorbic acid and tacrolimus.

Abstract

Management of triglyceride (TG) levels is essential in intensive care units (ICU), especially to manage the risk of pancreatitis induced by propofol. However, some therapeutics in ICU such as intravenous ascorbic acid protocol, especially used in the context of Covid-19 could lead to false decrease of triglycerides by analytical disruption of Trinder reaction. We report here the case of a sample with unmeasurable triglyceride levels partly due to high plasma ascorbic acid levels. However, repeated measure on the same sample four days later revealed that interference mechanism on TG was still present whereas the level of ascorbic acid was very reduced by oxidation degradation. Hence, additional interference mechanism was suspected. After clinical investigation, we found that the patient had also received high doses of tacrolimus due to a transplant. As previous studies reported that tacrolimus treatment lead to a decrease of the measured plasma activity of lipoprotein lipase (LPL), we hypothesized that tacrolimus or related metabolites could also interfere by direct inhibition of LPL involved in TG analytical method used.