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. 1981 Aug;57(670):511–515. doi: 10.1136/pgmj.57.670.511

Severe hypertriglyceridaemia responding to insulin and nicotinic acid therapy.

S R Smith
PMCID: PMC2426118  PMID: 7029504

Abstract

A patient with unusually severe hypertriglyceridaemia (serum concentration initially 258 mmol/l or 22600 mg/dl) and hypercholesterolaemia is reported and discussed. The triglyceride elevation was found to reside within the very low density lipoprotein fraction and was probably attributable to the combination of diabetes mellitus and familial hypertriglyceridaemia. Treatment with insulin and restriction of dietary carbohydrate led to a 50% reduction in the triglyceride concentration, and the addition of nicotinic acid in modest doses led ultimately to a complete normalization of the patient's lipid values. A close correlation was noted between the falling triglyceride concentration and the rising serum sodium concentration during the course of successful therapy. Overall, it is felt likely that this patient's severe and reversible hypertriglyceridaemia was on the basis of excessively rapid lipolysis leading to high concentrations of very low density lipoprotein production. Combined therapy with insulin and nicotinic acid is recommended for other patients of this nature.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brunzell J. D., Chait A., Bierman E. L. Pathophysiology of lipoprotein transport. Metabolism. 1978 Sep;27(9):1109–1127. doi: 10.1016/0026-0495(78)90157-9. [DOI] [PubMed] [Google Scholar]
  2. Brunzell J. D., Hazzard W. R., Motulsky A. G., Bierman E. L. Evidence for diabetes mellitus and genetic forms of hypertriglyceridemia as independent entities. Metabolism. 1975 Oct;24(10):1115–1121. doi: 10.1016/0026-0495(75)90148-1. [DOI] [PubMed] [Google Scholar]
  3. Brunzell J. D., Hazzard W. R., Porte D., Jr, Bierman E. L. Evidence for a common, saturable, triglyceride removal mechanism for chylomicrons and very low density lipoproteins in man. J Clin Invest. 1973 Jul;52(7):1578–1585. doi: 10.1172/JCI107334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brunzell J. D., Porte D., Jr, Bierman E. L. Reversible abnormalities in postheparin lipolytic activity during the late phase of release in diabetes mellitus (postheparin lipolytic activity in diabetes). Metabolism. 1975 Oct;24(10):1123–1137. doi: 10.1016/0026-0495(75)90149-3. [DOI] [PubMed] [Google Scholar]
  5. Brunzell J. D., Schrott H. G. The interaction of familial and secondary causes of hypertriglyceridemia: role in pancreatitis. Trans Assoc Am Physicians. 1973;86:245–254. [PubMed] [Google Scholar]
  6. Dietary and drug treatment of primary hyperlipoproteinemia. Ann Intern Med. 1972 Aug;77(2):267–294. doi: 10.7326/0003-4819-77-2-267. [DOI] [PubMed] [Google Scholar]
  7. François J., Lentini F., Hoste P., Rottiers R. Genetic study of hyperlipoproteinaemia types IV and V. Clin Genet. 1977 Oct;12(4):202–207. doi: 10.1111/j.1399-0004.1977.tb00927.x. [DOI] [PubMed] [Google Scholar]
  8. Kudchodkar B. J., Sodhi H. S., Horlick L., Mason D. T. Mechanisms of hypolipidemic action of nicotinic acid. Clin Pharmacol Ther. 1978 Sep;24(3):354–373. doi: 10.1002/cpt1978243354. [DOI] [PubMed] [Google Scholar]
  9. Kyner J. L., Levy R. I., Soeldner J. S., Gleason R. E., Fredrickson D. S. Lipid, glucose, and insulin interrelationships in normal, prediabetic, and chemical diabetic subjects. J Lab Clin Med. 1976 Sep;88(3):345–358. [PubMed] [Google Scholar]
  10. Levy R. I. The effect of hypolipidemic drugs on plasma lipoproteins. Annu Rev Pharmacol Toxicol. 1977;17:499–510. doi: 10.1146/annurev.pa.17.040177.002435. [DOI] [PubMed] [Google Scholar]
  11. McGarry J. D. Lilly Lecture 1978. New perspectives in the regulation of ketogenesis. Diabetes. 1979 May;28(5):517–523. doi: 10.2337/diab.28.5.517. [DOI] [PubMed] [Google Scholar]
  12. Nikkilä E. A., Huttunen J. K., Ehnholm C. Postheparin plasma lipoprotein lipase and hepatic lipase in diabetes mellitus. Relationship to plasma triglyceride metabolism. Diabetes. 1977 Jan;26(1):11–21. doi: 10.2337/diab.26.1.11. [DOI] [PubMed] [Google Scholar]
  13. Olefsky J. M., Farquhar J. W., Reaven G. M. Reappraisal of the role of insulin in hypertriglyceridemia. Am J Med. 1974 Oct;57(4):551–560. doi: 10.1016/0002-9343(74)90006-0. [DOI] [PubMed] [Google Scholar]
  14. Papadopoulos N. M., Kintzios J. A. Varieties of human serum lipoprotein pattern: evaluation by agarose gel electrophoresis. Clin Chem. 1971 May;17(5):427–429. [PubMed] [Google Scholar]
  15. Rautela G. S., Liedtke R. J. Automated enzymic measurement of total cholesterol in serum. Clin Chem. 1978 Jan;24(1):108–114. [PubMed] [Google Scholar]
  16. Sabesin S. M., Hawkins H. L., Kuiken L., Ragland J. B. Abnormal plasma lipoproteins and lecithin-cholesterol acyltransferase deficiency in alcoholic liver disease. Gastroenterology. 1977 Mar;72(3):510–518. [PubMed] [Google Scholar]
  17. Streja D., Kallai M. A., Steiner G. The metabolic heterogeneity of human very low density lipoprotein triglyceride. Metabolism. 1977 Dec;26(12):1333–1344. doi: 10.1016/0026-0495(77)90029-4. [DOI] [PubMed] [Google Scholar]
  18. Yeshurun D., Gotto A. M., Jr Drug treatment of hyperlipidemia. Am J Med. 1976 Mar;60(3):379–396. doi: 10.1016/0002-9343(76)90755-5. [DOI] [PubMed] [Google Scholar]

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