Heparin treatment of extreme hypertriglyceridemia

Extreme hypertriglyceridemia is a significant threat when it occurs in hospitalized patients. It typically presents itself as a call from the lab that the patient's serum is lipemic. The patient is at risk for acute pancreatitis if s/he doesn't already have it. Compounding the management difficulty is the interference by lipemia with certain laboratory procedures, the best example of which is pseudohyponatremia although there are also other laboratory problems, and special analytical methods are needed.

The Archives of Internal Medicine presents a case report and literature review of the use of heparin to rapidly clear triglycerides. The patient in question had DKA. Because lipemia is often post prandial NPO status itself may reduce triglycerides to a safe level. Insulin is a cofactor for lipoprotein lipase and its use often results in rapid triglyceride clearance. This patient proved refractory, and low dose intravenous heparin added to the regimen was effective. Heparin promotes release of lipoprotein lipase from endothelial cells

Like this paper, most of the literature concerning heparin for the treatment of extreme hypertriglyceridemia is anecdotal or composed of small case series. The reported effects, however, have been dramatic and the effect has been known for decades. Drugs such as fibrates and fish oil are indicated long term but their action may be too slow for the acute situation.

Here are some papers on heparin treatment of hypertriglyceridemic pancratitis: [1] [2] [3] [4].