742: ACUTE INFARCTS AND SEIZURES DUE TO EXTREME HYPERTRIGLYCERIDEMIA IN A NEWLY DIAGNOSED DIABETIC

Erin Wiltchik, Dafne T. Moretta

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Learning Objectives: Hypertriglyceridemia (HTG) is a wellknown cause of acute pancreatitis (AP). In extreme cases, patients with considerably elevated serum triglyceride levels may also develop hyperviscosity syndrome. Here we describe a unique case of extreme HTG (>3000 mg/dL) as the cause of cerebral ischemia. Methods: A 54-year-old obese female presented to the emergency room after being found unresponsive by family. En route to the hospital, she developed an episode of tonic-clonic seizure. Multiple doses of Lorazepam were administered with little to no improvement in convulsive activity. Patient was ultimately intubated and sedated due to status epilepticus and started on multiple anticonvulsants. Of note, the patient had a history of bipolar disorder on Lamictal and had been recently diagnosed with insulin dependent type 2 Diabetes Mellitus. Concomitantly, she was hypertensive, tachycardic, febrile and hyperglycemic with an elevated anion gap metabolic acidosis (26 mmol). She was started on an insulin infusion for Diabetes Ketoacidosis. Initial neuroimaging revealed restricted diffusion of the right occipital pole. Electroencephalogram (EEG) demonstrated diffuse background slowing with rare epileptiform discharges. Within a day, her blood pressure dramatically decreased and required vasopressor support. This prompted an extensive infectious disease workup ultimately revealing pancreatitis with a lipase level of 923 u/L. Simultaneously, the nurse reported thick, milky appearing blood samples arousing suspicion for HTG. A lipid panel demonstrated extremely elevated triglycerides (3432 mg/dL) and VLDL (686.4 mg/dL). Immediately, the insulin infusion parameters were increased will the goal of reducing triglyceride levels and plasmapheresis therapy was initiated. The triglyceride level decreased (147 mg/dL) and repeat brain CT had no evidence of an acute infarct. Her mental status improved and the patient was eventually extubated without complications or neurological deficits. Results: Triglyceride-mediated hyperviscosity may contribute to impaired vasomotor tone, tissue ischemia, and other stroke-like symptoms. In this case, the transient brain ischemia and persistent seizure activity was likely triggered by an increase in plasma viscosity. Early treatment of extreme HTG will reduce plasma viscosity and thus increase end-organ perfusion.
Original languageAmerican English
Pages (from-to)350-350
Number of pages1
JournalCritical Care Medicine
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2019

Disciplines

  • Critical Care
  • Medicine and Health Sciences

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