Intensive insulin therapy and plasma exchange in hypertriglyceridaemic acute pancreatitis with multiple organ dysfunction.

Acute pancreatitis (AP) is a common emergency in gastroenterology. After gallstone disease and alcoholism, hypertriglyceridaemia (HTG) is the next common cause for AP. The role of intensive insulin therapy (IIT) and plasma exchange (PE) in hypertriglyceridaemic acute pancreatitis (HTG-AP) is still debatable. We report a 56-year-old farmer with HTG-AP who presented with a recurrence of AP. On admission, his plasma triglycerides were 4773 mg/dl with a wide range of laboratory abnormalities. Over the course of his illness, he developed multiple organ failure. He received early IIT initially, and PE once haemodynamic stability was achieved. This approach improved the functioning of the organs. In haemodynamically unstable patients with HTG-AP, we suggest early initiation of IIT, followed by adjuvant PE after the resolution of shock, to ameliorate organ dysfunction and improve overall outcome.