Letters to the Editor
Milk-Like Serum Suggests Markedly Elevated Triglycerides
Am Fam Physician. 2004 Sep 1;70(5):821.
to the editor: Occasionally, clinicians encounter a finding that is rarely seen, and thus is worth sharing. The accompanying figure is a serum sample from a 60-year-old woman with diabetes who presented for evaluation of severe abdominal pain, nausea, and vomiting that had been worsening over a 24-hour period. She denied any chest pain, shortness of breath, fever, or chills. A nonfasting lipid panel revealed a triglyceride level of 8,535 mg per dL (96.3 mmol per L; normal range: 40 to 150 mg per dL [0.45 to 1.69 mmol per L]). Her lipase level was elevated at 1,476 U per L (normal range: 23 to 300 U per L).
Approximately 1.3 to 3.8 percent of cases of acute pancreatitis may be secondary to hypertriglyceridemia.1 Serum triglyceride levels of about 1,000 mg per dL (11.29 mmol per L) can precipitate such attacks, although the exact mechanism is unknown. When the triglyceride level is above 4,500 mg per dL (50.81 mmol per L), as in this patient, the serum is described as lactescent (milk-like). Such appearance should prompt the physician to get an immediate lipid level.1
1. Fortson MR, Freedman SN, Webster PD 3d. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90:2134–9.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Navy Medical Department or the U.S. Navy Service at large.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions