CASE PRESENTATION: 31-year-old male with history of alcohol abuse, presented with complaint of epigastric abdominal pain, associated with nausea and vomiting for one day duration. On physical examination, he was afebrile and had moderate epigastric tenderness. Laboratory data revealed WBC 8,500 /µL, Na 109 meq/L, Cl 82 meq/L, bicarbonate 13 meq/L, BUN 18 mg/dL, creatinine 3.46 mg/dL, an anion gap of 14. Glucose was 137 mg/dL and lipase was 1,348 U/L. The patient was admitted to medical intensive care unit where his clinical status rapidly deteriorated requiring intubation and mechanical ventilation. His lipid profile showed TG level of 12,730 mg/dL. One-volume plasmapheresis performed which reduced the TG level to 1883mg/dL. The patient was then placed on heparin and insulin infusion. Subsequent TG levels were 610, 354, 124 mg/dL. His AP was complicated with acute respiratory distress syndrome required mechanical ventilation for 11 days, pleural effusion required thoracentesis, sepsis treated with antibiotics and large pancreatic pseudocyst formation. He survived a complicated and prolonged hospitalization and was discharged home on oral gemfibrozil.