Triglyceride concentrations raised

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. 

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... 

Alterations in lipid metabolism are common and include increases in serum triglyceride and cholesterol concentrations, sometimes persisting after withdrawal of the therapy, and reductions in high-density lipoprotein cholesterol. The incidence of raised serum lipids during therapy with oral isotretinoin 1 mg/kg/day for acne has been reviewed retrospectively in 876 patients, of whom 54 had raised serum cholesterol concentrations (over 5.2 mmol/1) and 45 had triglyceride concentrations above 2.26 mmol/1 (57). 

Raised triglycerides due to olanzapine usually involve weight gain accompanied by insulin resistance. However, serum triglyceride concentrations can rise without weight gain or abnormal glucose metabolism [39, 40 ]. 

Lovaza (omega-3-acid ethyl esters) is a prescription form of concentrated fish oil EPA 465 mg and docosahexaenoic acid 375 mg. The daily dose is 4 g/day, which can be taken as four 1-g capsules once daily or two 1-g capsules twice daily. This product lowers triglycerides by 14% to 30% and raises HDL by about 10%. 

Free fatty acids, whose levels are generally raised by insulin or alcohol, influence the rate of VLDL synthesis and hence the concentration of triglycerides. About 16 g glycerol, which are mainly utilized in the liver, are released daily by lipolysis, and about 120 g free fatty acids are made available for generating energy in the heart and skeletal musculature (75%) as well as in the liver itself (25%o). These free fatty acids are bound in the plasma to albumin (50%) and lipoproteins (50%). Their extremely short plasma half-life of approx. 2 minutes emphasizes their high metabolic activity. Fatty acids are present in the plasma in saturated (no double bond) and unsaturated (various numbers of double bonds) forms. Essential fatty acids cannot be synthesized by the body, which means they must be obtained from food intake. The most important ones are multiple unsaturated fatty acids such as linolic acid (Cis-fatty acid, 2 double bonds), linolenic acid (Ci8-fatty acid, 3 double bonds), and arachidonic acid (C2o-fatty acid, 4 double bonds). Their prime function is to act as precursors for the synthesis of eicosan-oids. (s. fig. 3.10)... 

In a Couette apparatus, i.e., between two concentric cylinders, of which the outer one of radius 10 cm is rotating at 180 revolutions per minute and the inner stationary one has a radius of 9.5 cm some triglyceride oil is present. The temperature is 20°C. How long will it take before the temperature is raised to 21 °C, assuming that no heat loss from the oil to the environment occurs Tip Some useful data are in Table 9.2. 

Chronic ethanol ingestion can increase serum concentrations of VLDL and triglyceride. This is one of the factors that puts patients with alcoholism at risk of pancreatitis. Chronic ethanol ingestion also has the possibly beneficial effect of raising, not decreasing, serum HDL concentrations. The answer is (E). 

Overall, fibrates decrease plasma triglyceride levels much more dramatically than they decrease plasma cholesterol levels. They significantly decrease VLDL levels, cause a moderate Increase In HDL levels, and have variable effects on LDL concentrations. As an example of this latter point, gemfibrozil will raise LDL levels In patients with hypertriglyceridemia but lower LDL levels in patients with normal triglyceride levels. The exact mechanisms for these actions have not been fully elucidated however, studies have shown that this class of compounds can produce a variety of beneficial effects on lipoprotein metabolism. Many of these effects have been proposed to be mediated through the activation of peroxisome proliferator-activated receptors (PPARs) and an alteration of gene expression. Specifically, fibrates bind to PPARa (7,15,27,44). 

It is characterised by moderately raised triglycerides, low high-density lipoprotein (HDL)-chole-sterol, and the accumulation of cholesterol-enriched remnant lipoprotein particles. Total and LDL-cholesterol concentrations mainly reflect those of the background population but there are important qualitative changes in LDL particle distribution. 

---