Patient With Gemfibrozil-Controlled Hypertriglyceridemia That Developed Acute Pancreatitis After Starting Ketogenic Diet

Curr Surg. Mar-Apr 2004;61(2):224-6. doi: 10.1016/S0149-7944(03)00159-4.


Objective: To report the case of a patient with gemfibrozil-controlled hypertriglyceridemia (HTG) that developed acute pancreatitis several days after starting a high-fat ketogenic diet.

Methods: The patient was evaluated and treated by the authors.

Results: The patient denied viral prodrome or previous symptoms, ethanol consumption, or a known history of cholelithiasis. He was compliant with his gemfibrozil regimen. Clinical examination revealed a tachycardic, febrile, moderately distressed man with exquisite tenderness across the left flank and left abdomen. Laboratory studies revealed increased serum amylase (114 U/L), lipase (530 U/L) and triglyceride (>1000 mg/dL) concentrations. There was a borderline leukocytosis (12800 WBC/mm(3)). Computed tomography of the abdomen demonstrated enlargement and marked inflammatory change to the pancreas. Abdominal ultrasonography revealed no evidence of cholelithiasis or pancreatobiliary obstruction. These findings were diagnostic of HTG-induced acute pancreatitis.

Conclusion: Ketogenic diets may cause a substantial increase in serum triglycerides and, as a result, may precipitate HTG-induced pancreatitis in those with abnormal lipid metabolism. Patients with a history of HTG should be advised of the potentially deleterious correlation between ketogenic diets and pancreatic function.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Abdominal Pain / etiology
  • Acute Disease
  • Adult
  • Amylases / blood
  • Dietary Carbohydrates / administration & dosage
  • Dietary Fats / adverse effects*
  • Fever / etiology
  • Gemfibrozil / therapeutic use*
  • Humans
  • Hypertriglyceridemia* / complications
  • Hypertriglyceridemia* / drug therapy
  • Hypertriglyceridemia* / metabolism
  • Hypolipidemic Agents / therapeutic use*
  • Ketones / metabolism
  • Lipase / blood
  • Male
  • Obesity / complications
  • Obesity / diet therapy
  • Obesity / metabolism
  • Pancreatitis / diagnosis
  • Pancreatitis / etiology*
  • Pancreatitis / metabolism
  • Precipitating Factors
  • Tachycardia / etiology
  • Tomography, X-Ray Computed
  • Triglycerides / blood


  • Dietary Carbohydrates
  • Dietary Fats
  • Hypolipidemic Agents
  • Ketones
  • Triglycerides
  • Lipase
  • Amylases
  • Gemfibrozil