Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

774 Hypertriglyceridemia

■presentation: nausea, vomiting, abdominal pain

➣additional symptoms:

angina, myocardial infarction, stroke, claudication

➣signs:

eruptive xanthoma, lipemia retinalis, hepatosplenomegaly

tests

Laboratory

■basic blood studies:

➣fasting lipid panel: elevated triglyceride, total cholesterol normal

or elevated, HDL cholesterol usually low, LDL cholesterol low,

normal or elevated

➣glucose, HgbA1c

➣thyroid function tests

■basic urine studies:

➣proteinuria

■ECG

Specific Diagnostic Tests

■Apolipoprotein E genotype

Imaging

■none

differential diagnosis

■Chylomicronemia (present when triglycerides >1,000 mg/dl)

■Dysbetalipoproteinemia (elevated cholesterol and triglyceride with

apolipoprotein E2 genotype)

■Familial combined hyperlipidemia (elevated cholesterol and triglyc-

eride in patient or in various family members)

■Familial hypertriglyceridemia

➣Secondary causes:

Diabetes mellitus

Uremia

Nephrotic syndrome

Alcohol abuse

Estrogen use

Pregnancy

Metabolic stress

Glycogen storage disease

Dysglobulinemia

Lipodystrophy