Effectiveness of Intensive Insulin Therapy in the Management of Acute Necrotizing Pancreatitis Induced by Very Severe Hypertriglyceridemia

HTG is defined as fasting serum triglyceride more than 1.7 mmol/L. It is classified as mild (1.7-2.2 mmol/L), moderate (2.3-11.2 mmol/L), severe (11.2-22.4 mmol/L) and very severe (>22.4 mmol/L)4. There is a five percent risk of developing acute pancreatitis with severe HTG and 10% to 20% risk with very severe HTG5. Although patients with HTG-P present with similar complaints to other etiologies inducing pancreatitis, studies suggest that the risk of complications are more severe with HTG-P3,6. The exact mechanism and pathophysiology of HTG inducing pancreatitis is still not clearly established; yet, several medical treatment modalities such as plasmapheresis, apolipoprotein CII infusion and intensive insulin therapy and heparin infusion were reported7-11.