Case Report Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy Natasha Gupta, Seema Ahmed, Lemuel Shaffer, Paula Cavens, and Josef Blankstein Department of Obstetrics and Gynecology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA Correspondence should be addressed to Natasha Gupta; docnatasha3@gmail.com Received 15 February 2014; Revised 1 May 2014; Accepted 23 May 2014; Published 3 June 2014 Academic Editor: Muktar Aliyu Copyright © 2014 Natasha Gupta et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural efusion, and chronic pericarditis. his patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis. 1. Introduction Hypertriglyceridemia associated with pregnancy occurs due to normal, physiological changes of pregnancy, involving increased sex hormone levels. Gestational hypertriglyc- eridemia is usually not very severe and does not result in medical or obstetric complications. his physiological increase in lipid levels can be exacerbated by an underlying abnormality of lipid metabolism, leading to catastrophic consequences such as acute pancreatitis. We report such a case of severe gestational hypertriglyceridemia that leads to acute pancreatitis and other associated complications, even in absence of any underlying genetic defects of lipid metabolism. 2. Case Presentation We report a 32-year-old Hispanic female gravida ive para four, at 38-week and four-day gestational age, who presented with severe epigastric pain, of one-day duration. She com- plained of several episodes of emesis but denied any uterine contractions, fever, chills, or diarrhea. She had no history of similar pain in the past. She had no history of alcohol use, drug intake, gallstones, pancreatitis, or similar episode in previous pregnancies. Upon examination, her blood pres- sures were elevated to systolic 150–160s and diastolic 90s. Other vital signs were normal. Her cervical os was dilated to 2 cms dilatation, with 50% efacement and −3 station. Abdomen was noted to be nontender, with no evidence of appendicitis or cholecystitis. Her laboratory studies showed sodium 121 meq/L (normal range: 136–146 meq/L), potassium 3.1 meq/L (normal range: 3.5–5.1 meq/L), lactate 2.3 mmol/L (normal range: 0.5–2.2 mmol/L), amylase 1617 U/L (nor- mal range: 16–96 U/L), lipase 1330 U/L (normal range: 22– 51 U/L), and normal liver function tests (Table 1). Urinalysis showed 2+ proteinuria (100 mg/dL) and ketones 150 mg/dL. hus, a diagnosis of mild preeclampsia and acute pancreatitis was made based on patient’s symptomatology and elevated amylase and lipase levels. She was admitted for conservative management of acute pancreatitis and induction of labor for preeclampsia. She received magnesium sulfate for seizure prophylaxis and intravenous hydration as resuscitative mea- sure. During the course of this treatment, she spontaneously progressed to a cervical dilatation of 5 cms, but her condition deteriorated as suggested by maternal and fetal tachycardia as well as metabolic acidosis on arterial blood gas anal- ysis. Repeat laboratory studies were signiicant for lactate Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2014, Article ID 485493, 5 pages http://dx.doi.org/10.1155/2014/485493