Describe the Goal-directed IV fluid therapy.
Fluids and infusion rate
Crystalloids such as normal saline (NS) or lactated Ringer's solution (LR) are preferred.
Monitor vitals, oxygen saturation, and urine output.
Obtain laboratory studies (CBC, BMP, HCT) every 6–12 hours to monitor adequacy of fluid resuscitation and tissue perfusion.
Perform serial physical examination to assess for abdominal compartment syndrome.
Replete electrolytes as needed.
Intravenous fluid resuscitation in the first 12–24 hours has the greatest impact on the clinical outcome of patients with acute pancreatitis.
Describe the supportive therapy.
NSAIDS (e.g., ketorolac, diclofenac, ibuprofen)
Opioids (e.g., meperidine, hydromorphone, morphine)
Antiemetics as needed (e.g., ondansetron, metoclopramide)
Prophylactic antibiotics are not recommended, and should only be used in patients with evidence of infected necrosis.
Describe the nutrition.
Early oral feeding: Begin as soon as tolerated (i.e., not causing pain, nausea, or vomiting), ideally within 24 hours.
Enteral tube (nasogastric or nasojejunal): preferred over parenteral nutrition if patients cannot tolerate oral intake
Parenteral nutrition (total or partial): only in patients who cannot tolerate enteral feeds (e.g., those with persistent paralytic ileus)
Bowel rest is no longer routinely recommended. Enteral nutrition, via oral route or enteral tube, should be initiated as early as tolerated.
Describe the treatment of biliary pancreatitis as the underlying cause.
Indication: biliary pancreatitis associated with cholangitis or persistent CBD obstruction
Timing: Urgent therapeutic ERCP (within < 24 hours) is indicated if there is concurrent cholangitis.
Procedure: sphincterotomy and stone removal; see “Treatment of choledocholithiasis”
Complications: aggravation of pancreatitis, perforation, hemorrhage
Indication: all patients with biliary pancreatitis to prevent recurrence
Timing: recommended during the initial admission for patients with mild biliary pancreatitis
Describe the treatment of hypertriglyceridemia-induced pancreatitis as the underlying cause.
Initiate measures to rapidly decrease triglyceride levels alongside fluid resuscitation and analgesia.
Plasmapheresis and hemofiltration
Evaluate for secondary causes of hypertriglyceridemia ; consider screening for familial hypertriglyceridemia if none are present.
Initiate long-term lipid-lowering therapy e.g., with fibrates, as soon as tolerated to prevent recurrences.
Dietary and lifestyle modifications