A. Sura 1 , R. Granieri 1 ; 1 University of Pittsburgh, Pittsburgh, PA (Tracking ID #73858) LEARNING OBJECTIVES: 1. To recognize the impact of severely elevated triglycerides 2. To recognize the common causes of acute pancreatitis 3. To evaluate and manage the patient presenting with acute pancreatitis CASE INFORMATION: KD is a 17 year old female with a history of hypertriglyceridemia who presented to the emergency department with severe abdominal pain, nausea, and vomiting. She also complained of dizziness and lightheadedness. She denied alcohol use, medication use, family history of pancreatitis, history of gallstones or trauma. Although her symptoms were similar in character to her previous episodes of pancreatitis, they were much more severe. At the time of presentation, she was febrile to 103 degrees Fahrenheit and orthostatic. Her examination revealed significant abdominal distention, absent bowel sounds, and exquisite diffuse tenderness to palpation. There was no rebound tenderness. Her lab work revealed a hemoglobin of 6.8 (normal for her was 15), WBC 15.8, albumin 2.3, calcium 6.5 and triglyceride level of 11,000. Lab work also showed Na 133, K 3.3, Cl 100, CO2 22, BUN <2, Cr 0.4, glucose 217, lipase 1221, amylase 117, triglycerides >11,000, total cholesterol 245, HDL 14, Ca 7.4, albumin 2.3, Tbili 1.6, AST 25, ALT 22, GGT 83 and alkaline phosphatase 96. CT scan of the abdomen revealed severe necrotizing pancreatitis with necrosis of the pancreatic duct, large amount of ascites, and a large retroperitoneal phlegmon. She was started on imipenem, given blood transfusions, and maintained NPO. She was admitted to the ICU for severe necrotizing pancreatitis. IMPLICATIONS/DISCUSSION: Acute pancreatitis is an acute inflammatory process of the pancreas. It is associated with severe acute upper abdominal pain and elevated serum levels of pancreatic enzymes. Most cases are associated with gallstones or alcohol, but the precise pathogenetic mechanisms are not understood completely. Other causes of acute pancreatitis include biliary sludge, post-procedure, hypertriglyceridemia, hypercalcemia, drugs, trauma, HIV, and hereditary causes (pancreas divisum or a genetic mutation). The diagnosis is made via clinical exam, laboratory findings, and, if needed, imaging studies. CT scan is the most helpful imaging test for the diagnosis and its intrabdominal complications. Serum triglyceride concentrations above 1000 mg/dl can precipitate attacks of acute pancreatitis and may account for 1.3±3.8% of cases. The clinical manifestations of hypertriglyceridemia associated pancreatitis are similar to those seen with other causes with the exception that, for poorly understood reasons, the serum amylase may not be elevated substantially. Clinical assessment of severe pancreatitis is as accurate as most scoring systems. Treatment of acute pancreatitis is aimed at correcting predisposing factors and at the pancreatic inflammation itself. General management consists of supportive care with intravenous hydration, pain management, antibiotics, parenteral or enteral (jejunal) feeding, and in severe cases, necrosectomy.