pancreatitis%20-%20acute
PANCREATITIS - ACUTE
Acute pancreatitis is inflammation of the pancreas that occurs suddenly.
Abdominal pain is the most prominent symptom of acute pancreatitis.
It is diagnosed by at least two of the following: Characteristic abdominal pain, serum lipase and/or amylase levels ≥3 times the upper limit of normal and characteristic abdominal imaging findings.
Mild acute pancreatitis does not have any organ failure or local or systemic complication.
Moderately severe acute pancreatitis has the presence of local or systemic complication and/or transient organ failure in <48 hours.
Severe acute pancreatitis has single or multiple organ failure persistent in >48 hours.

Supportive Therapy

Fluid Resuscitation

  • Timely and sufficient fluid resuscitation is critical in the prevention of complications of acute pancreatitis (eg hypovolemia and organ hypoperfusion) 
    • Fluid resuscitation may also be associated with earlier resolution of organ failure
  • Aggressive hydration should be given to all patients and adjusted according to patient’s age, weight and pre-existing cardiac and/or renal conditions
    • 250-500 mL/hour of isotonic crystalloid solution is given in the 1st 12-24 hours
    • Goal is to achieve clinical and biochemical targets of perfusion (eg heart rate, mean arterial and central venous pressures, hematocrit and BUN) 
  • Balanced electrolyte solution (normal saline, Ringer’s lactate) should be given quickly and rate titrated based on frequent assessment of the patient’s volume status
    • 5-10 L of fluid daily may be needed for the 1st several days of illness
    • The daily basic requirement as well as third-space fluid losses should be included in the computation for fluid replacement
  • Careful monitoring of volume status is crucial in patients with compromised cardiovascular or respiratory systems
  • Check and measure intra-abdominal pressure regularly
  • Fluid administration should continue until it is ensured that risk of organ failure has passed

Respiratory Care

  • SaO2 should be measured continuously and O2 should be administered to maintain arterial SaO2 >95%
  • If signs of respiratory insufficiency develop, assess for pulmonary edema or acute respiratory distress syndrome (ARDS) and treat appropriately
    • Assess the need for endotracheal intubation and ventilatory support

Cardiovascular (CV) Support

  • CV complications include shock, congestive heart failure, arrhythmias and myocardial infarction (MI)
  • Crystalloids or colloids may be needed to maintain adequate intravascular volume and urine output
  • Inotropics eg Dopamine may be used in hypotension

Metabolic Balance

  • Hyperglycemia may be carefully managed with Insulin
  • Magnesium (Mg) or Ca replacement may be required
  • A brief alcohol intervention is recommended to be given during admission in patients with acute alcoholic pancreatitis

Nasogastric Tube

  • Routine nasogastric intubation is not beneficial in mild pancreatitis
  • If protracted vomiting occurs, ileus should be assessed by abdominal X-ray and nasogastric tube inserted to protect against aspiration
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