All right, so welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas,

and we're going to talk about hypertriclaclylydic pancreatitis. Josh, I think you enjoyed this,

that I think I know something, and then you just pull the rug from under my feet, and you change

everything I do overnight. So today we're going to talk about the classic approach to this, so filter all that lipemic

blood out, nuke them with the insulin and heparin, and then bobs your uncle.

But you want to start off with an argument of how this happens and why it's the free fatty

acids that are causing trouble and why we should change our approach.

So let's get straight into this. This is very evidence-based. There's tons of stuff to tell us how to treat this, right?

Yeah, not really. I mean, like every single chapter in the IBCC, there's not a lot of evidence, but I think especially for hypertroglystereidemia, there's very little evidence here.

And it's kind of amazing the extent

to which people have performed relatively invasive and expensive procedures on these patients on a long,

large-scale basis with really minimal evidentiary support. So we're going to do our best.

We used to leach people. Okay. That's the same thought. Just bleed them until it's good, right?

No, and honestly, I've all of the mistakes described in this chapter I've made, so I'm

not saying that I'm any better than anyone else.

I'm just, the evidence is minimal.

Like, if you came out and said, like, we should do plasma foresis for COVID, like, you

would get buried in hatred.

But if you said the same thing about hypertroglyceridemic packatitis, people like, okay,

that's cool.

Point well taken, that may be just supportive care like many, many things we've covered

and in our daily jobs, supportive care

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