Synopsis
Confirm dangerous triglyceride elevation, prevent and recognise acute pancreatitis, reverse secondary drivers rapidly, and coordinate dietary, diabetes, lipid and genetic specialist treatment.
- Triglycerides between 10 and 20 mmol/L require a fasting repeat after at least five days but within two weeks, plus immediate review of secondary causes.
- Seek specialist advice if the repeat fasting concentration remains above 10 mmol/L; refer urgently above 20 mmol/L when alcohol or poor glycaemic control does not explain it.
- Acute pancreatitis risk rises substantially with severe triglyceride elevation, but pain and organ dysfunction determine emergency care rather than a lipid number alone.
Key red flags
Persistent severe epigastric pain radiating to the back with vomiting, ileus, tachycardia or hypotension requires emergency assessment; the triglyceride may fall after fasting, so obtain an early sample.
Investigation priorities
Confirm severe elevation after a high non-fasting result and quantify immediate risk.
Management branches
A non-fasting triglyceride concentration is between 10 and 20 mmol/L.
- Ask immediately about abdominal pain, vomiting, alcohol, diabetes symptoms, pregnancy and triglyceride-raising medicines, sending symptomatic patients to acute assessment.
- Arrange a fasting repeat after at least five days and within two weeks while beginning correction of obvious secondary drivers and giving alcohol and dietary safety advice.
Key medicines
Fenofibrate for severe hypertriglyceridaemiaA common adult oral regimen is 160 mg once daily for the relevant tablet formulation; exact dose varies by product and renal function, so verify the current BNF and specialist plan.
Insulin for DKA or severe hyperglycaemiaUse the current fixed-rate intravenous insulin and fluid protocol for DKA, or the specialist inpatient glycaemic regimen for another hyperglycaemic emergency, with hourly glucose and electrolyte monitoring.