Pancreatitis, acute

K85.0-3/K85.8-9

DESCRIPTION

Acute inflammatory condition of the pancreas.
Acute pancreatitis is based on the fulfilment of ‘2 out of 3’ of the following criteria:

  • clinical (upper abdominal pain),
  • laboratory (serum amylase or lipase >3x upper limit of normal), and/or
  • imaging (CT, MRI, ultrasonography) criteria.

Intense local inflammation results in pain and local as well as systemic complications. DIC, metabolic derangements and shock may occur.
Renal function, electrolytes and calcium, can be used to determine severity.

GENERAL MEASURES

Nasogastric suction when persistent vomiting or ileus occurs.
Parenteral fluid replacement to correct metabolic and electrolyte disturbances.
Parenteral nutrition is associated with adverse outcomes and should only be considered in patients that cannot receive or tolerate nasogastric or enteral nutrition.
Drainage of abscess, pseudocyst, if required.

MEDICINE TREATMENT

For pain:

  • Morphine, IV, to a total maximum dose of 10 mg (See MORPHINE, IV, for individual dosing and monitoring for response and toxicity).

Acute symptomatic hypocalcaemia E83.5

  • Calcium gluconate 10%, IV infusion, 10 mL as a bolus over 10 minutes.
    • Follow with 60–120 mL diluted in 1 L sodium chloride 0.9%, administered over 12–24 hours.
    • Monitor serum calcium at least 12 hourly.

LoEIII

If serum magnesium < 0.5 mmol/L:

ADD

  • Magnesium sulfate, IV infusion, 25–50 mmol in 12–24 hours.
    • 1 mL magnesium sulfate 50% = 2 mmol magnesium.

Antimicrobial therapy

The administration of prophylactic antibiotics are not necessary.

For abscess of the pancreas:

Broad spectrum IV antibiotics:

  • Amoxicillin/clavulanic acid, IV, 1.2 g 8 hourly for 10 days, depending on clinical response.

LoEIII [7]

REFERRAL

Severe complications, e.g. necrosis, haemorrhagic or systemic complications, infective pancreatitis.