Multiorgan System Dysfunction in the Chylomicronemia Syndrome. (May 2014)

• Record Type: Journal Article
• Authors: Argula, Rahul G.; Strange, Charlie; Budisavljevic, Milos N.
• Is Part Of: Journal of intensive care medicine. Volume 29:Number 3(2014:May/Jun.)
• Page Start: 175
• Page End: 178
• Publication Date: 2014-05
• Subjects: hypertriglyceridemia -- hyperviscosity -- plasmapheresis -- chylomicronemia -- acute respiratory failure -- multiorgan system dysfunction; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/0885066613475425
• Languages: English
• ISSNs: 0885-0666

Abstract

Objective: To describe an extreme presentation of the chylomicronemia syndrome resulting in multiorgan system dysfunction. Patient: A 40-year-old African American male with no past medical history presented with multiorgan system dysfunction manifested by acute respiratory failure and acute kidney injury. He was noted to have very-high triglyceride levels (>5000 mg/dL) at admission. Interventions: An echocardiogram showed normal cardiac function. Amylase and lipase were normal. We confirmed the chylomicronemia syndrome with a triglyceride assay. The associated hyperviscosity was treated with plasmapheresis to reduce the plasma triglyceride level. Results: After 3 sessions of plasmapheresis, his triglyceride levels were significantly reduced, his oxygenation improved, and his acute kidney injury resolved. He was successfully extubated on day 7 of the intensive care unit stay. His diabetes and hypertriglyceridemia were newly diagnosed and drug therapy was instituted with home discharge on day 14. Conclusions: Severe chylomicronemia can cause multiorgan system dysfunction related to hyperviscosity. Early institution of plasmapheresis to reduce the triglyceride-rich lipoproteins can improve tissue perfusion and prevent further organ damage.