Acute Pancreatitis admission

Presentation:

Patient could be drinking excessive Alcohol, had history of pancreatitis or cholelithiasis or using medications that could cause pancreatitis, might have had ERCP recently or infections or idiopathic

ER:

Routine Labs

Amylase, Lipase

US of RUQ or CT scan of abdomen

Pain meds

NPO

Aggressive IV Fluids

Hospitalist:

Continue IV fluids upto 125-150ml/hr depending on patient

Bowel rest

Pain Management with Narcotics IV-Morphine/Dilaudid

GI and DVT prophylaxis

Antibiotics ( Imipenem) for necrotizing pancreatitis more than 30%

Lipid panel-if Triglycerides are very high, sometimes patient can end up on Hemodialysis due to severe renal failure.

GI consult-may do ERCP if this is caused by obstruction with gall stones, stricture, sludge etc.

Severe pancreatitis patients need ICU management, TPN for nutrition support

Ranson Criteria gives one point for each Category:

Ranson Criteria: 

 At Admission                                                         During First 48hrs

 Age > 55                                                                   Hematocrit Drop > 10%

WBC > 16,000                                                   Serum Calcium < 8

Glucose > 200                                           Base Defecit > 4

LDH > 350                                                         Increase in BUN > 5

AST > 250                                                            Fluid Sequestration > 6L

                                                                      Arterial PO2 < 60

5 % Mortality risk with < 2 signs

15-20%Mortality with 3-4 signs

40% Mortality with 5-6  signs

99% Mortality with > 7 signs