Therapeutic plasma exchange for severe hyperlipidaemia in a patient with poorly controlled diabetes

Description

Hypertriglyceridaemia (HTG) is a common condition in the USA and is often caused or exacerbated by uncontrolled diabetes mellitus (DM), obesity and other metabolic disorders. It is usually asymptomatic until triglycerides exceed 1000 mg/dL. Signs include gastrointestinal pain, nausea, vomiting and dyspnoea. In type I DM, insulin deficiency leads to an inhibition of lipoprotein lipase (LpL).1 Control with insulin restores LpL function and reduces triglyceride levels. While initiating glucose control, therapeutic plasma exchange (TPE) can be used adjunctively, with intravenous insulin, to rapidly decrease triglyceride levels and prevent acute pancreatitis.

A man of 30 with poorly controlled type I DM, secondary to gallstone pancreatitis, presented for treatment of abdominal pain, nausea, vomiting and HTG. His father also has HTG, but no genetic testing for inherited lipid disorders has been pursued. The patient's initial glucose level was 335 mg/dL and his HbA1c was 14.2%. His lipid panel included...

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