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Gebelik sırasında gelişen hipertrigliseridemiye bağlı akut pankreatit tedavisinde heparin ve insulin faydalı mıdır?

Gebeliğin komplikasyonu olarak gelişen akut pankreatit nadir olup, daha önce yüksek mortaliteyle seyrettiği bildirilmiştir. Dördüncü gebeliklerinde konjenital hipertirigliseridemiye bağlı akut pankreatit gelişen iki vaka sunulmuştur. Vakalardan biri klasik tedaviye ilaveten düşük lipitli diyet ve diğeri de klasik tedaviye ilaveten düşük lipitli diyet, glukoz-insulin ve düşük molekül ağırlıklı heparinle tedavi edildi. Her iki hasta da klinik ve laboratuvar tam düzelmeyle hastaneden taburcu edildi.

Anahtar Kelimeler:

Gebelik, hipertrigliseridemi, akut pankreatit, insulin, heparin

Are heparin and insulin beneficial in the treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy?

Acute pancreatitis complicating pregnancy is rare and has previously been associated with high mortality rates. We report two patients with congenital hypertriglyceridemia and hypertriglyceridemia-induced acute pancreatitis in their fourth gestation. Conventional treatment modality plus fat restriction diet was used in one of the patients, while conventional treatment, fat restriction diet, glucose-insulin and low molecular weight heparin were used in the other. Both patients were discharged from the hospital with complete clinical and laboratory improvement.

Keywords:

Pregnancy, hypertriglyceridemia, acute pancreatitis, insulin, heparin,

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Mizushima T, Ochi K, Matsumura N et al. Prevention of hyperlipidemic acute pancreatitis during pregnancy with medium-chain triglyceride nutritional support. Int J Pancreatol 1998; 23: 187-92.
Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis: presentation and management. Curr Opin Lipidol 2009; 20: 497-504.
Gan SI, Edwards AL, Symonds CJ, Beck PL. Hypertriglyceridemia-induced pancreatitis: A case based review. World J Gastroenterol 2006; 12: 7197-202.
Gürsoy A, Kulaks›zo¤lu M, fiahin M, et al. Severe hypertriglyceridemia-induced pancreatitis during pregnancy. J Nat Med Ass 2006; 98: 655-7.
Kwak SW, Kim S, Lee JW, et al. Evaluation of unusual causes of pancreatitis: Role of cross-sectional imaging. Eur J Radiol 2009; 71: 296-312.
Potter JM, Nestel PJ. The hyperlipidemia of pregnancy in normal and complicated pregnancies. Am J Obstet Gynecol 1979; 133: 165-70.
Knopp RH, Warth MR, Charles D, et al. Lipoprotein metabolism in pregnancy, fat transport to the fetus and the effects of diabetes. Biol Neonate 1986: 50: 297-317.
Loo CC, Tan JY. Decreasing the plasma triglyceride level in hypertriglyceridemia-induced pancreatitis in pregnancy: A case report. Am J Obstet Gynecol 2002; 187: 241-2.
Takaishi K, Miyoshi J, Matsumura T, et al. Hypertriglyceridemic acute pancreatitis during pregnancy: prevention with diet therapy and omega-3 fatty acids in the following pregnancy. Nutrition 2009; 25: 1094-7.
Abu Musa AA, Usta IM, Rechdad JB, Nassar AH. Recurrent hypertriglyceridemia-induced pancreatitis in pregnancy: a management dilemma. Pancreas 2006; 32: 227-8.
Alagözlü H, Cindoruk M, Karakan T, Ünal S. Heparin and insulin in the treatment of hypertriglyceridemia-induced severe acute pancreatitis. Dig Dis Sci 2006; 51: 931-3.
Fallat RW, Vester JW, Glueck CJ. Suppression of amylase activity by hypertriglyceridemia. JAMA 1973; 225: 1331-4.