HYPERLIPIDEMIA IN ACUTE-PANCREATITIS - CAUSE OR EPIPHENOMENON

Whether hyperlipidemia is a pre-existing metabolic disorder or a conse quence of acute pancreatitis is still debated. Mild to moderate elevat ion of serum triglyceride levels are likely to be an epiphenomenon of the pancreatic disease. A marked hyperchylomicronemia and hypertryglic eridemia would be needed to trigger acute pancreatitis; a relevant def ect in the lipid catabolism and clearance should therefore pre-exist. The aim of the present study was to investigate whether patients with acute pancreatitis and marked hyperlipidemia have an impaired clearanc e capacity of exogenous lipids, which would define the hyperlipidemia as a pre-existent abnormality and therefore a potential cause of the p ancreatic disease. With this aim, the kinetics of the removal of exoge nous triglycerides from the circulation have been analyzed. Twenty pat ients with acute pancreatitis have been studied. Ten of them suffered from an episode of acute pancreatitis with marked hyperlipidemia (seru m triglyceride levels >20 mmol/L). Four to six months after recovery f rom the pancreatitis, a two-stage infusion of Intralipid 20% was carri ed out and the fractional removal rate (K-2) and the maximal clearance capacity (K-1) of exogenous triglycerides were calculated At low infu sion rates a first order kinetics for removal was observed, whereas at high infusion rates a zero order kinetics was operating. All patients with a previous attack of normolipidemic acute pancreatitis had norma l K-2 and K-1 values. Five patients with previous hyperlipidemic acute pancreatitis had an abnormally low clearance capacity of exogenous tr iglycerides, whereas the remaining five had normal removal values. The present study provides new information in the association between hyp erlipidemia and acute pancreatitis by showing that even a marked eleva tion of serum lipid levels should not be invariably considered as the etiological factor of the pancreatic disease, even if other potential causes are not evident.