Serum triglyceride concentrations

LT044 Scribner, K. A., T. M. Gadbois, M. Gowri, S. Azhar, and G. M. Reaven. Masoprocol decreases serum triglyceride concentrations in rats with fructose-induced hypertriglyceridemia. Metabolism 2000 49(9) 1106-1110. 

Two individuals with serum triglyceride concentrations over 11.3 mmol/1 (1000 mg/dl) were referred to a pharma-cist-managed lipid clinic by their primary-care provider because of either treatment failure or intolerance of conventional therapies (14). Fish oils were used in one case in lieu of and in the other in addition to conventional treatments. Although fish oil has not been reported to cause hepatotoxicity, both of these patients had increased transaminases while taking fish oil. Whether fish oil truly causes hepatic injury remains to be elucidated. 

In healthy subjects who took either fish oil or olive oil (control) daily for 3 weeks before exposure to aspirin or no aspirin, fish oil had no significant effect on mucosal prostaglandin E2 or F2 content or on the damaging effect of aspirin on the stomach, despite the fact that fish oil reduced serum triglyceride concentrations significantly (19). 

The ion exchange resins tend to increase serum triglyceride concentrations, especially in patients with hypertriglyceridemia (1). 

Amiodarone can cause altered serum lipid concentrations (78). Serum cholesterol rises, as can blood glucose and serum triglyceride concentrations. The mechanisms of these effects are not known nor is it known to what extent they are due to changes in thyroid function. 

Phenytoin increases high-density lipoprotein (HDL) cholesterol (118), and may also increase total cholesterol and serum triglyceride concentrations (SED-13,143) (119). In a 5-year prospective study with carbamazepine, there was a persistent rise in total cholesterol and HDL cholesterol, whereas triglycerides and low-density lipoprotein (LDL) cholesterol increased only transiently (120). In a more recent study, total cholesterol fell when 12 patients were switched from carbamazepine to oxcarbazepine, but HDL cholesterol and triglycerides were unchanged (121). In a comparison of 101 epileptic patients with matched controls, valproate was associated with lower total and LDL cholesterol, whereas carbamazepine was associated with higher HDL cholesterol and apolipoprotein A concentrations and phenobarbital with higher concentrations of total and HDL cholesterol and apolipoproteins A and B. The ratio of total to HDL cholesterol was reduced with valproate and carbamazepine but not with phenobarbital (122). 

Three patients also developed chylomicronemia and two of those had severe hypertriglyceridemia. All three patients had triglycerides over 2 pg/ml before treatment, suggesting that patients with abnormal serum triglyceride concentrations at baseline are more likely to develop marked hypertriglyceridemia. 

People with severe hypertriglyceridemia associated with Type V hyperlipoproteinemia may be at increased risk of hypervitaminosis A, even with moderate degrees of vitamin A supplementation (1199). Long-term vitamin A administration is associated with an increase in serum cholesterol and serum triglyceride concentrations (1200) and consequently might be linked with atherosclerosis (SEDA-8, 345) (1201,1202). 

Samuelsson O, Pennert K, Andersson O, Berglund G, Hedner T, Persson B, Wedel H, Wilhelmsen L. Diabetes mellitus and raised serum triglyceride concentration in treated hypertension—are they of prognostic importance Observational study. BMJ 1996 313(7058) 660-3. 

Fig. 8. (A) Effects of aging and caloric restriction on the serum triglyceride concentration in male F344 rats. Adapted from reference 28. (B) Effect of aging on the serum total cholesterol concentration in male F344 rats. Adapted from reference 28.

A 51-year-old woman with a past medical history of a seizure disorder, schizophrenia, and asthma, who had been admitted with pneumonia, was sedated using a propofol infusion to assist mechanical ventilation (65). Over 7 days she received a total of 26.5 g of propofol at a maximum rate of 0.2 mg/kg/minute. When pancreatitis, which was associated with hypertriglyceridemia, was diagnosed, the propofol infusion was stopped. In addition to raised amylase activity, serum triglyceride concentrations peaked at 17 mmol/1 and lipase activity at 564 U/1. She recovered over the next 7 days. On day 17 she underwent tracheostomy revision, during which... 

Figure 16-4 Central 95% reference interval.The 2,5 and 97,5 percentiles and their 0.90 confidence intervals of the 500 serum triglyceride concentrations (Figure i 6-3), as determined by the parametric method (see text). The curves are the estimated probability distributions.

The precision of a percentile as an estimate of a population value depends on the size of the subset it is less precise when there are few observations. If the assumption of random sampling is fulfilled, we may determine the confidence interval of the percentile (i.e., the limits within which the true percentile is located with a specified degree of confidence) (Figure 16-4). The 0.90 confidence interval of the 97.5 percentile (upper reference limit) for serum triglycerides may, for example, be 2.22 to 2.62mmol/L. We would expect to find the true percentile in this interval with a confidence of 0.90 if we measured aU serum triglyceride concentrations in the total reference population. 

The table shows an example using the 500 serum triglyceride concentrations displayed in Figure 16-3. See the text for a description of the nonparametric method. The unit of all concentrations in the table is imnol/L. 

The total serum lipid concentration is reduced by physical conditioning serum cholesterol may be lowered by as much as 25%. HDL cholesterol, however, is increased. Thus the decrease in total cholesterol concentration is mostly due to a reduction in low-density lipoprotein (LDL) cholesterol. The concentration of serum apolipoprotein A-1 increases with training, whereas the concentration of apolipoprotein B decreases. The serum triglyceride concentration may be reduced by up to 20mg/dL (0.23mmoI/L), but the free fatty acid concentration is higher in fit individuals than others. Loss of body fat is associated with improvement in hpid concentrations. The lactate response to exercise is... 

The general metabolic response to shock includes the normal response to stress with mobilization of lipids, although the serum triglyceride concentration is not usually affected. Following acute myocardial infarction and other cardiac events there tend to be notable decreases in LDL and HDL cholesterols, and apolipoprotein B and A-I concentrations with an increase in the triglyceride concentration. Surgical procedures and intercurrent iUnesses produce similar... 

Enteral feedings may also prevent infection by decreasing translocation of bacteria across the gut wall. Preliminary data suggest that probiotics such as lactobacillus (along with a fiber supplement) may reduce bacterial translocation and possibly decrease pancreatic necrosis and abscess. If enteral feeding is not possible, total parenteral nutrition (TPN) should be implemented before protein and calorie depletion becomes advanced. Intravenous lipids should not be withheld unless the serum triglyceride concentration is greater than 500 mg/dL. At present, there is no clear evidence that nutritional support alters outcome in most patients with AP unless malnutrition exists. ... 

Bile acid-binding resins may be used to lower cholesterol in transplant patients, but adequate doses are difficult to achieve without the development of GI adverse effects. Because the absorption of CSA is dependent on the presence of bile in the GI tract, patients should be instructed to separate dosing of bile acid-binding resins and CSA by at least 2 hours. Bile acid-binding resins also should be separated from other immunosuppressants by at least 2 hours to avoid physical adsorption in the GI tract. For transplant patients who have hypertriglyceridemia refractory to dietary intervention, fish oil and fibric acid derivatives are well-tolerated, effective alternatives (see Chap. 21). Fibric acid derivatives are most effective in lowering serum triglyceride concentrations. 

Hypertriglyceridemia, defined as serum triglyceride concentrations of 400 to 500 mg/dL in adults and 150 to 200 mg/dL in preterm infants, neonates, and older pediatric patients, may occur in patients receiving IVLE-based PN. Risk factors include preexisting liver or pancreatic dysfunction, sepsis, multiple organ failure, degree of prematurity, rate of IVLE infusion, and dose. ... 

Lipid intolerance is common in acute renal failure, requiring careful monitoring of serum triglyceride concentrations before and during intravenous lipid administration. 

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