Hypertriglyceridemia, discovered on a pseudohyponatremia, induced by L-asparaginase in the treatment of B acute lymphoblastic leukemia in child

We report the case of a 6-year-old girl, admitted at the 32th days of chemotherapy induction of a B acute lymphoblastic leukemia for pseudohyponatremia (121 mmol/L), which revealed a major hypertriglyceridemia (125 g/L). The milky aspect of blood samples was remarquable. We suspected a hypertriglyceridemia induced by L-asparaginase. We introduced a treatment by hyperhydratation, insulinotherapy, free fat diet and one plasmapheresis. Decrease of hypertriglyceridemia was quickly observed. However on the tenth day she presented a pancreatitis. Fenofibrate, ursodeoxycholic acid and heparin were added. Clinical improvement allowed discharge from hospitalization at day 16.