Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Matthew Feldt, DO
Start Date
9-5-2023 11:30 AM
End Date
9-5-2023 1:30 PM
Presentation Type
Abstract
Description
Background: Severe hypertriglyceridemia (SHTG) is defined as triglyceride (TG) >= 1000 mg/dL and increases the risk of developing acute pancreatitis. Insulin activates lipoprotein lipase which accelerates chylomicron degradation leading to a rapid decrease in TG levels. There is a paucity of pediatric standard of care for insulin use to treat SHTG.
Objectives/Goal: Our objective was to develop a protocol to standardize SHTG management using insulin infusion and decrease the duration of SHTG resolution while preventing hypoglycemia.
Methods/Design: Endocrinology, Evidence-Based Practice, Hospital Medicine, Critical Care, Gastroenterology, Pharmacy, and Nursing met to develop the protocol. Pediatric and adult literature were reviewed, and the protocol (Figure 1) was based on consensus as evidence was limited. Retrospective chart review of patients with SHTG during the protocol implementation and from the year prior, for comparison, were reviewed. This study was determined exempt by our institution’s IRB.
Results: The protocol was used in 3 patients and compared to 4 patients the year prior to protocol implementation. Patient with protocol use: None had DKA. The maximum rate of insulin was 0.25 unit/kg/hr and was achieved for the PEG-asparaginase patient who was on 20% dextrose given the presence of central line. Patient without protocol use: The 2 T1D also presented in DKA, where insulin infusion was continued after DKA resolution due to persistent SHTG. It is worthwhile noting that the new diagnosis of diabetes had a shorter resolution of SHTG between 9-38 hours compared to the known diabetes.
Conclusions: A protocol to standardize the management of SHTG using insulin infusion was developed. Patients with SHTG where the protocol was used did not have hypoglycemia. The protocol has been used on a limited number of patients since implementation to be able to evaluate its effectiveness.
MeSH Keywords
severe hypertriglyceridemia; intravenous insulin; pediatrics
Additional Files
1357-Erica Maris Wee-Abstract.pdf (109 kB)Abstract
SHTG_Figure1.pdf (294 kB)
Figure 1
Inpatient Insulin Management for Severe Hypertriglyceridemia in Pediatrics
Background: Severe hypertriglyceridemia (SHTG) is defined as triglyceride (TG) >= 1000 mg/dL and increases the risk of developing acute pancreatitis. Insulin activates lipoprotein lipase which accelerates chylomicron degradation leading to a rapid decrease in TG levels. There is a paucity of pediatric standard of care for insulin use to treat SHTG.
Objectives/Goal: Our objective was to develop a protocol to standardize SHTG management using insulin infusion and decrease the duration of SHTG resolution while preventing hypoglycemia.
Methods/Design: Endocrinology, Evidence-Based Practice, Hospital Medicine, Critical Care, Gastroenterology, Pharmacy, and Nursing met to develop the protocol. Pediatric and adult literature were reviewed, and the protocol (Figure 1) was based on consensus as evidence was limited. Retrospective chart review of patients with SHTG during the protocol implementation and from the year prior, for comparison, were reviewed. This study was determined exempt by our institution’s IRB.
Results: The protocol was used in 3 patients and compared to 4 patients the year prior to protocol implementation. Patient with protocol use: None had DKA. The maximum rate of insulin was 0.25 unit/kg/hr and was achieved for the PEG-asparaginase patient who was on 20% dextrose given the presence of central line. Patient without protocol use: The 2 T1D also presented in DKA, where insulin infusion was continued after DKA resolution due to persistent SHTG. It is worthwhile noting that the new diagnosis of diabetes had a shorter resolution of SHTG between 9-38 hours compared to the known diabetes.
Conclusions: A protocol to standardize the management of SHTG using insulin infusion was developed. Patients with SHTG where the protocol was used did not have hypoglycemia. The protocol has been used on a limited number of patients since implementation to be able to evaluate its effectiveness.
