PLASMAPHERESIS FOR THE TREATMENT OF HYPERTRIGLYCERIDEMIA. C. Carosella 1 , C. Karmen 1 , S. Warshafsky 1 , Y. Murray 1 ; 1 New York Medical College, Valhalla, NY (Tracking ID #76460) LEARNING OBJECTIVES: To recognize the value of plasmapheresis in the treatment of triglyceride-induced acute pancreatitis. CASE INFORMATION: A 50-year-old Hispanic woman with a history of insulin-dependent diabetes mellitus, coronary artery disease and hypertriglyceridemia presented to the emergency room with severe abdominal pain, nausea, vomiting and poor oral intake all gradually worsening over the prior two weeks. She had been treated with a combination of atorvastatin, gemfibrozol, and niacin with only marginal success in controlling her lipid levels. Physical exam revealed an ill-appearing woman complaining of abdominal pain. Bowel sounds were hypoactive, and the abdomen was diffusely tender. The serum was grossly lipemic. Laboratory studies revealed a glucose of 1321 mg/dl, amylase of 1008 mg/dl, lipase 2001 mg/dl, and triglycerides 9198 mg/dl. CT scan of the abdomen was consistent with acute pancreatitis. Her condition rapidly deteriorated with respiratory failure, requiring ventilator support, and renal failure, requiring dialysis. She was transferred to the University Hospital for plasmapheresis. One plasmpheresis treatment with continuous infusion of heparin lead to a substantial and sustained reduction of triglyceride level to less than 150 mg/dl. The patient steadily improved with decreased dependence on the ventilator, increased urine output, and decreased swelling of the pancreas. Unfortunately, the patient suffered a cardiac arrest on the sixteenth hospital day. IMPLICATIONS/DISCUSSION: Plasmapheresis has been used to treat hypertriglyceridemia when adequate diet and drug therapy fail. In this case plasmapheresis was highly effective in removingthetriglyceridesand mayhave ledto thepatient'ssteady,albeit temporary,improvement. (1) to recognize hyperammonemia due to acute valproic acid intoxication (2) to manage hyperammonemia due to acute valproic acid intoxication by understanding its mechanism.