INS and pancreatitis: After consultation with Endocrinology, the patient was admitted for an insulin infusion with glucose-containing maintenance fluids to help treat the very severe hypertriglyceridemia. The patient was discharged in good condition on hospital day 3 with triglyceride levels down to 405 mg/dL and prescribed a new oral agent, Icosapent ethyl at 2 g orally daily. Clinicians evaluating patients for acute abdominal complaints should be alert to the possible diagnosis of HLAC given the potential for deterioration to pancreatitis and concomitant complications.