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Abstract
Background: Acute pancreatitis is an inflammatory condition of the pancreas that can arise from various etiologies such as alcohol consumption, gallstones, hypertriglyceridemia, and use of certain medications. Hypertriglyceridemia is a significant risk factor for pancreatitis, especially in patients with uncontrolled diabetes mellitus. Medications like dipeptidyl peptidase-4 (DPP-4) inhibitors have also been implicated in rare cases of pancreatitis. This report presents a complex case of multifactorial acute pancreatitis in a patient with diabetes mellitus and dyslipidemia suspected to be induced by the medication Glyxambi and hypertriglyceridemia.
Case Presentation: A 48-year-old male with known history of diabetes mellitus and dyslipidemia presented to the emergency department with severe abdominal pain localized in the epigastric region. The pain was sharp, constant, radiating to the back, associated with nausea, and multiple episodes of vomiting. The patient's medication regimen included Glyxambi (empagliflozin and linagliptin), glimepiride, Vascepa (icosapent ethyl), and ezetimibe, which he had been taking for the treatment of his diabetes and dyslipidemia.
On physical examination, the patient had significant tenderness in the epigastric region without signs of peritoneal irritation. Vital signs were stable. Laboratory tests revealed elevated triglyceride levels (5870 mg/dL). Abdominal computed tomography showed peripancreatic adiposity adjacent to the pancreatic head, suggestive findings of acute pancreatitis. Pancreatic enzyme levels, including amylase and lipase, were within normal limits. The diagnosis of pancreatitis was made based on clinical and imaging criteria.
The patient was admitted to the intensive care unit (ICU) and was started on insulin infusion to rapidly reduce his triglyceride levels. Additional supportive care included intravenous fluids, pain control with analgesics, and antiemetics for nausea and vomiting. His triglyceride levels decreased gradually, and his abdominal pain resolved. He was discharged after 5 days on glargine, fenofibrate, icosapent ethyl and discontinued glyxambi.
Discussion: The hypothesis of pancreatitis in this patient is multifactorial, likely induced by Glyxambi and exacerbated by severe hypertriglyceridemia. Glyxambi combines empagliflozin, an inhibitor of sodium-glucose cotransporter-2 (SGLT2), and linagliptin, a DPP-4 inhibitor. Although SGLT2 inhibitors are not commonly associated with pancreatitis, DPP-4 inhibitors like linagliptin have been implicated in rare cases of pancreatitis with an increased incidence of acute pancreatitis of 1- 2 cases per 1000 patients on DPP-4 inhibitors. His extreme hypertriglyceridemia was a clear culprit in leading to pancreatitis, as this is a commonly known trigger, however we hypothesize that Glyxambi could have potentially contributed as well.
The potential role of Glyxambi in precipitating pancreatitis, along with severe hypertriglyceridemia underscores the need for thorough medication review and monitoring. This case highlights the importance of considering multifactorial causes in the diagnosis and management of acute pancreatitis, especially in patients with complex medical histories. It is important for physicians to be familiar with these newer medications that may precipitate pancreatitis in patients who are at risk and consider discontinuing in patients who have prior episodes of pancreatitis.
Presentation Type
Poster
Recommended Citation
Mogollon, Ivan; Matos, Catherine; Lopez, Michelle; Gomez, Juan; Ortiz, Juan; Calero, Juan; and Lema, Rodrigo, "Multifactorial Pancreatitis in a Patient with Dyslipidemia and Diabetes, Potential Role of Glyxambi: Case Report" (2024). Research Colloquium. 72.
https://scholarworks.utrgv.edu/colloquium/2024/posters/72
Included in
Multifactorial Pancreatitis in a Patient with Dyslipidemia and Diabetes, Potential Role of Glyxambi: Case Report
Background: Acute pancreatitis is an inflammatory condition of the pancreas that can arise from various etiologies such as alcohol consumption, gallstones, hypertriglyceridemia, and use of certain medications. Hypertriglyceridemia is a significant risk factor for pancreatitis, especially in patients with uncontrolled diabetes mellitus. Medications like dipeptidyl peptidase-4 (DPP-4) inhibitors have also been implicated in rare cases of pancreatitis. This report presents a complex case of multifactorial acute pancreatitis in a patient with diabetes mellitus and dyslipidemia suspected to be induced by the medication Glyxambi and hypertriglyceridemia.
Case Presentation: A 48-year-old male with known history of diabetes mellitus and dyslipidemia presented to the emergency department with severe abdominal pain localized in the epigastric region. The pain was sharp, constant, radiating to the back, associated with nausea, and multiple episodes of vomiting. The patient's medication regimen included Glyxambi (empagliflozin and linagliptin), glimepiride, Vascepa (icosapent ethyl), and ezetimibe, which he had been taking for the treatment of his diabetes and dyslipidemia.
On physical examination, the patient had significant tenderness in the epigastric region without signs of peritoneal irritation. Vital signs were stable. Laboratory tests revealed elevated triglyceride levels (5870 mg/dL). Abdominal computed tomography showed peripancreatic adiposity adjacent to the pancreatic head, suggestive findings of acute pancreatitis. Pancreatic enzyme levels, including amylase and lipase, were within normal limits. The diagnosis of pancreatitis was made based on clinical and imaging criteria.
The patient was admitted to the intensive care unit (ICU) and was started on insulin infusion to rapidly reduce his triglyceride levels. Additional supportive care included intravenous fluids, pain control with analgesics, and antiemetics for nausea and vomiting. His triglyceride levels decreased gradually, and his abdominal pain resolved. He was discharged after 5 days on glargine, fenofibrate, icosapent ethyl and discontinued glyxambi.
Discussion: The hypothesis of pancreatitis in this patient is multifactorial, likely induced by Glyxambi and exacerbated by severe hypertriglyceridemia. Glyxambi combines empagliflozin, an inhibitor of sodium-glucose cotransporter-2 (SGLT2), and linagliptin, a DPP-4 inhibitor. Although SGLT2 inhibitors are not commonly associated with pancreatitis, DPP-4 inhibitors like linagliptin have been implicated in rare cases of pancreatitis with an increased incidence of acute pancreatitis of 1- 2 cases per 1000 patients on DPP-4 inhibitors. His extreme hypertriglyceridemia was a clear culprit in leading to pancreatitis, as this is a commonly known trigger, however we hypothesize that Glyxambi could have potentially contributed as well.
The potential role of Glyxambi in precipitating pancreatitis, along with severe hypertriglyceridemia underscores the need for thorough medication review and monitoring. This case highlights the importance of considering multifactorial causes in the diagnosis and management of acute pancreatitis, especially in patients with complex medical histories. It is important for physicians to be familiar with these newer medications that may precipitate pancreatitis in patients who are at risk and consider discontinuing in patients who have prior episodes of pancreatitis.