Recently, Hanh Phuc International Hospital successfully treated a case of severe acute pancreatitis caused by a rare underlying condition in a patient with complex endocrine and metabolic disorders. Patient N.T.K.A., a 36-year-old woman from Binh Phuoc province, was admitted in critical condition with severe epigastric and right hypochondrial pain, accompanied by frequent vomiting of bile.

Diagnosis and Treatment Process

The patient had given birth at Hanh Phuc International Hospital eight months prior and had been diagnosed with type 2 diabetes. She also had a history of gallstones, which had not been monitored or treated.

Upon admission, she presented with severe abdominal pain, signs of infection (elevated white blood cell count and CRP), extremely high blood sugar levels (23.07 mmol/L), ketonemia (4.96 mmol/L), and metabolic acidosis (blood pH: 7.289; pCO₂: 37.2 mmHg; HCO₃: 17.8 mmol/L). Notably, her lipid profile revealed severe hypertriglyceridemia (62.53 mmol/L, compared to the normal range of 0.46–1.88 mmol/L). Blood tests and a CT scan confirmed a diagnosis of moderate acute pancreatitis due to hypertriglyceridemia, accompanied by diabetic ketoacidosis and underlying gallstones.

Acute Pancreatitis Due to Hypertriglyceridemia – A Therapeutic Challenge

Recognizing the severity of the case, the hospital promptly activated a multidisciplinary consultation protocol involving:

• Emergency Department: initial management and stabilization
• Endocrinology and Metabolism: management of blood lipids, glucose, ketoacidosis, and electrolyte imbalances
• General Surgery: evaluation of surgical indications for gallstone removal

Thanks to this well-coordinated approach, the patient received immediate and intensive treatment, which included:

• Control of triglycerides, blood sugar, and ketones using aggressive fluid resuscitation and intravenous insulin via syringe pump, with hourly capillary glucose monitoring and regular reassessments of blood gases, electrolytes, and renal function
• Symptomatic support: temporary fasting, pain relief, and antiemetic medication

Marked Improvement After Intensive Management

Within 24–48 hours of treatment, the patient showed significant improvement, with reduced pain and cessation of vomiting. Triglyceride and blood glucose levels were successfully controlled, and oral feeding was gradually reintroduced under a lipid- and glucose-controlled diet. After 72 hours, she resumed eating normally. By day 8, the pancreatitis had significantly improved, and the patient was discharged in stable condition with normalized laboratory results. She was advised to continue regular monitoring of her endocrine and metabolic conditions and to undergo laparoscopic cholecystectomy once fully recovered from pancreatitis.

Medical Insights

Acute pancreatitis is a frequently encountered gastrointestinal condition that commonly necessitates hospitalization. The diagnosis is established when at least two of the following three criteria are fulfilled: the presence of characteristic abdominal pain, elevated levels of pancreatic enzymes (such as amylase or lipase), and radiological findings consistent with pancreatic inflammation. The most prevalent etiologies include gallstone disease, which accounts for approximately 40–70% of cases, and excessive alcohol consumption, responsible for 25–35% of cases.

According to Dr. Chu Minh Tuan, General Surgeon at Hanh Phuc International Hospital:
“Currently, the incidence of hyperlipidemia-induced acute pancreatitis (HLAP) is on the rise, particularly in Asia, with a prevalence of 10–15%. Alarmingly, HLAP can progress to severe stages with a mortality rate of up to 20% if not promptly treated. In remote areas, mortality can reach 40% in cases of pancreatic necrosis or multi-organ failure. Studies indicate that HLAP is often associated with more severe clinical outcomes and higher mortality than other forms of pancreatitis, especially in younger patients (<50 years), and is more common in males.”.

Dr. Nguyen Nhat Nam, Endocrinologist and lead physician in the case, added:
“Diabetes and dyslipidemia often co-occur as part of a broader condition known as metabolic syndrome. Patients with metabolic disorders face a high risk of long-term complications such as cardiovascular events (heart attacks, strokes) as well as life-threatening acute conditions like ketoacidosis and pancreatitis. This highlights the importance of regular follow-up visits and strict adherence to prescribed treatments for those with diabetes and lipid disorders.”

This case serves as a powerful example of the essential role of multidisciplinary treatment in managing complex medical conditions. The close collaboration between the Endocrinology, Surgery, and Emergency teams allowed the patient to overcome a life-threatening situation, minimize complications, and ensure optimal care outcomes.

Hanh Phuc International Hospital is committed to delivering high-quality, multidisciplinary healthcare—particularly in the fields of Endocrinology, Metabolism, and General Surgery—to ensure the utmost safety and well-being of our patients.

References:

• Mishra AK. Acute Pancreatitis. Clinical Pathways in Emergency Medicine. 2016 Feb 22:347–56. doi: 10.1007/978-81-322-2710-6_27
• Andrea P, Balázs K, Andrea S, et al. Prospective, Multicentre, Nationwide Clinical Data from 600 cases of Acute Pancreatitis. PLoS ONE. 2016;11:e0165309
• Sarri G, Guo Y, Iheanacho I, Puelles J. Moderately severe and severe acute pancreatitis: a systematic review of the outcomes in the USA and European Union-5. BMJ Open Gastroenterol. 2019 Feb 16;6(1):e000248

Medical Advisors:

• Dr. Chu Minh Tuan, General Surgeon
• Dr. Nguyen Nhat Nam, Endocrinologist

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