Hyperlipidemia Pancreatitis

Metabolic stress, familial hyperlipidemia, pancreatitis, excess IVFE dose rapid IVFE infusion rate... 

Hypertriglyceridemia Stress, familial hyperlipidemia, pancreatitis excess IVLE dose rapid IVLE infusion rate Decrease IVLE dose decrease rate of IVLE infusion discontinue IVLE if indicated... 

While the fibric acid derivatives have antihyperlipidemic effects, their use varies depending on the drug. For example, Clofibrate (Atromid-S) and gemfibrozil (Lopid) are used to treat individuals with very high serum triglyceride levels who present a risk of abdominal pain and pancreatitis and who do not experience a response to diet modifications. Clofibrate is not used for the treatment of other types of hyperlipidemia and is not thought to be effective for prevention of coronary heart disease. Fenofibrate (Tricor) is used as adjunctive treatment for the reduction of LDL, total cholesterol, and triglycerides in patients with hyperlipidemia. 

A complete history and physical examination should assess (1) presence or absence of cardiovascular risk factors or definite cardiovascular disease in the individual (2) family history of premature cardiovascular disease or lipid disorders (3) presence or absence of secondary causes of hyperlipidemia, including concurrent medications and (4) presence or absence of xanthomas, abdominal pain, or history of pancreatitis, renal or liver disease, peripheral vascular disease, abdominal aortic aneurysm, or cerebral vascular disease (carotid bruits, stroke, or transient ischemic attack). 

Hypertriglyceridemia Hypertriglyceridemia in adult patients (Types IV and V hyperlipidemia) who present a risk of pancreatitis and who do not respond to diet. Consider therapy for those with triglyceride elevations between 1000 and 2000 mg/dL, and who have a history of pancreatitis or of recurrent abdominal pain typical of pancreatitis. 

In addition, the alcohol addicts are liable to other neuropsychiatric syndrome (Korsakoff s psychosis) which is associated with hallucination, suicidal tendencies and encephalopathy. They may also suffer from hyperlipidemia, hyperuricemia, pancreatitis and hepatitis. 

The two major clinical sequelae of hyperlipidemias are acute pancreatitis and atherosclerosis. The former occurs in patients with marked hyperlipemia. Control of triglycerides can prevent recurrent attacks of this life-threatening disease. 

The decision to use drug therapy for hyperlipidemia is based on the specific metabolic defect and its potential for causing atherosclerosis or pancreatitis. Suggested regimens for the principal lipoprotein disorders are presented in Table 35-2. 

Stavudine NRTI1 Immediate release 30-40 mg bid, depending on weight3 Peripheral neuropathy, lipodystrophy, hyperlipidemia, rapidly progressive ascending neuromuscular weakness (rare), pancreatitis Avoid concurrent zidovudine and neuropathic drugs (eg, ddl, zalcitabine, isoniazid)... 

Monogenic dyslipoproteinemias can generally be grouped into five categories (1) hypertriglyceridemia with an increase in chylomicrons and the clinical sign of pancreatitis, (2) mixed hyperlipidemia with an increase in chylomicron and VLDL remnants and an increased risk of premature atherosclerosis, (3) hypercholesterolemia with an increase in LDL and an increased risk for premature atherosclerosis, (4) hypoalphalipoproteinemia with low HLD and an increased risk for premature atherosclerosis, and (5) hypolipoproteinemia with a decrease in VLDL and LDL, which may lead to neurological disease. 

The incidence of acute pancreatitis as a suspected complication of finasteride treatment has been examined in a case-control study in a Danish regional population of 490 000 over 7 years. Of 302 men aged 60 and older with incident acute pancreatitis, three had been exposed to finasteride of 2994 controls 37 had been exposed to finasteride. After adjustment for alcohol-related diseases, gallstone disease, hyperlipidemia, hypercalcemia, and hyperparathyroidism, the authors found no evidence of an increased risk of acute pancreatitis in users of finasteride (48). 

The consequences of hypertriglyceridemia are not well understood, but there may be an increased risk of cardiovascular disease and pancreatitis (SEDA-13, 123). Patients with an increased tendency to develop hypertriglyceridemia include those with diabetes mellitus, obesity, increased alcohol intake, and a positive family history. With a short course (16 weeks) of isotretinoin it is sufficient to ensure there is no hyperlipidemia before the start of therapy, and to determine the triglyceride response to therapy on one occasion after 4 weeks (1207). 

Gemfibrozil is indicated in the treatment of hypertriglyceridemia in adult patients with type IV or V hyperlipidemia that presents risk of pancreatitis and does not respond to diet and reduction of coronary heart disease risk in type Ilb patients who have low HDL levels (in addition to elevated LDL and triglycerides) and have not responded to other measures. 

In cases when gastrointestinal or pancreatic toxicity is present, plasma lipids will be affected. The nephrotic syndrome is characterized by hyperlipidemia, hypopro-teinemia, and hyperproteinuria in several species, and lipid changes may also be observed with chronic renal damage (Moestrup and Nielsen 2005). 

Fibrates are approved to treat hypertriglyceridemia and familial combined hyperlipidemia (Fredrickson s type lla, lib, IV, and V) (Table 30.2) in patients who are at risk of pancreatitis and have not responded to dietary adjustments or in patients who are at risk of CHD and have not responded to weight loss, dietary adjustments, and other pharmacological treatment. They can be used either alone or in combination with niacin, bile acid sequestrants, or FlMGRIs. If used with bile acid sequestrants, fibrates must be taken either 1 hour before or 4 to 6 hours after the sequestrant. As discussed previously and reemphasized below, caution should be used it fibrates are combined with HMGRIs. Fibrates are not effective in the treatment of hypertriglyceridemia associated solely to elevated chylomicron levels (Fredrickson s type I). 

E. Aoute pancreatitis with single or prolonged use can occur. Hyperlipidemia can also ocour after prolonged use. 

There are two major indications for the lowering of senxm lipids. One is the reduction of severe hyperlipidemia to (a) prevent lipid deposits (xanthomata) that can be disfiguring and occasionally painful and (b) elimination of abdominal pain and pancreatitis due to high lipid levels. The other rationale to reduce serum lipids is the strongly... 

It appears, however, that hemochromatosis-induced diabetes results in complications that are indistinguishable from diabetes mellitus (Becker and Miller, 1960 Dymock et al., 1972). Indeed several authors have suggested a common denominator that exists in both primary diabetes (e.g., IDDM and NIDDM) and diabetes secondary to pancreatic destruction and hemochromatosis, which eventually leads to the same vascular complications (Sheldon, 1935 Becker and Miller, 1960 Dymock et al., 1972). Conversely, iron mobilization and utilization appear to be delayed in diabetes mellitus. A possible link between iron overload and complications is further suggested by the observation that desferrioxamine treatment decreased hyperglycemia and hyperlipidemia in diabetic patients with high ferritin but without hemochromatosis (Cutler, 1989). 

In accordance with our interpretation of the term lipidoses as hereditary disorders of lipid metabolism, a review of secondary hyperlipidemias has not been attempted here. Since they are considered as associated phenomena of disorders such as diabetic ketoacidosis, nephrosis or pancreatitis, their exclusion seems to be justifiable. 

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