The diagnosis of hypertriglyceridemia is made by measuring plasma lipid levels after an overnight fast (≥12 h). Hypertriglyceridemia in adults is defined as a triglyceride level >2.3 mmol/L (>200 mg/dL). An isolated increase in plasma triglycerides indicates that chylomicrons and/or very low-density lipoprotein (VLDL) are increased. Plasma is usually clear when triglyceride levels are <4.5 mmol/L (<400 mg/dL) and cloudy when levels are higher due to VLDL (and/or chylomicron) particles becoming large enough to scatter light. When chylomicrons are present, a creamy layer floats to the top of plasma after refrigeration for several hours. Tendon xanthomas and xanthelasmas do not occur with isolated hypertriglyceridemia, but eruptive xanthomas (small orange-red papules) can appear on the trunk and extremities and lipemia retinalis (orange-yellow retinal vessels) may be seen when the triglyceride levels are >11.3 mmol/L (>1000 mg/dL). Pancreatitis is associated with these high concentrations.
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