The observation of opalescent blood when drawing samples from a patient with suspect acute pancreatitis is not uncommon in the emergency room, and the confirmation of massive hypertriglyceridaemia by the laboratory generally initiates the surgeon on duty to take a rapid contact with the internist colleague. Hypertriglyceridaemia is present in about one of ten patients with acute pancreatitis, and can frequently be linked to excessive alcolhol intake, uncontrolled diabetes, pregnancy or kidney failure. Since this is a very serious condition with high mortality, discussions about how to handle the patient often become intense, generally (correctly) concluding that there is limited evidence regarding optimal treatment. This article is protected by copyright. All rights reserved.