A 47-year-old man presented with severe acute pancreatitis, thought to be hypertriglyceridaemia-induced. Serum triglyceride concentration fell from 42.4 mmol/L to 5.9 mmol/L by day three with fasting alone. Hypertriglyceridaemia precipitates a small but significant proportion of acute pancreatitis episodes, especially during pregnancy. Treatment strategies are discussed, with special focus on plasmapheresis. The reduction in serum triglyceride concentration achieved by plasmapheresis is similar to that achieved by fasting alone, or in conjunction with insulin or heparin therapy. It is possible that plasmapheresis may offer the patient more harm than benefit. Currently, there is insufficient evidence to either recommend or reject plasmapheresis in triglyceride-induced acute pancreatitis.
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