Lipid abnormalities and acute pancreatitis

This is a good review with a small list of selected references to the literature. The conclusion is drawn that clinical and experimental evidence indicates that hypertriglyceridemia is the basic cause of acute pancreatitis and that lactescent serum alone suffices for the diagnosis in alcoholics with typical symptoms. Circulating pancreatic lecithinase probably accounts for the pulmonary complications often seen. This postulated etiology would explain the ineffectiveness of nasogastric suction and other standard therapeutic measures. Lactescent serum in the alcoholic with characteristic symptoms betokens that the hypertriglyceridemia may mask amylase elevation, making it an inconstant and therefore unreliable indicator of acute pancreatitis. The hypertriglyceridemia itself may be the basic cause of the acute pancreatitis associated with alcoholism, as well as of the pancreatitis associated with renal failure, the use of birth control pills, and with other conditions. Alcoholic pancreatitis, probably by far the most common type seen in the large hospital, should be managed with supportive therapy. It now seems apparent, on both clinical and theoretical grounds, that much of the standard regimen is ineffective and should be largely abandoned. In attacks of pancreatitis unrelated to alcoholism, one should determine the fasting triglyceride level. If it is elevated, the patient should be put on a low lipid diet and/or given clofibrate to lower serum lipids.