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Acute pancreatitis

  • Admission orders

    • Admit: Floor, ICU if severe
    • Diagnosis: Acute Pancreatitis
    • Condition: Stable
    • Vital Signs: Every 2 hours x 3, then q 4 hours
    • Allergies:
    • Nursing: Accurate I/Os, Daily weight, Assess and treat pain q 2 hours
    • Diet: NPO
    • Activity: up with assistance
    • Labs:
      • CBC, chem, Ca now and in AM
      • LFTs, Amylase, lipase
      • coags: PT, PTT
      • Abdominal ultrasound to assess for biliary cause of pancreatitis
      • consider CT
      • fasting lipid panel in AM
    • IV: NS at 250 mL/h for 3 Liters, then Call HO to Reassess
    • Special:
      • GI consult (ERCP for gallstone)
      • surgical consult (cholecystectomy for gallstone, pseudocyst, abscess, necrosis)
    • Medications:
      • Morphine sulfate 1-4 mg IV q 2 hours as needed for pain
      • if > 30% necrosis, then imipenem or peropenem prophylaxis
    • Call house officer: Call for SBP < 100, HR > 110, temperature > 38.5 C, increasing O2 requirement, or UO < 30 mL/h, averaged over 4 hours
  • Ranson's criteria

    • At admission
      • age > 70
      • WBC > 16 (18 for gallstone)
      • glc > 200 (220 for gallstone)
      • AST > 200 (250 for gallstone)
      • LDH > 350 (400 for gallstone)
    • Within 48 hours
      • Ca < 8
      • Hct fall > 10%
      • PO2 < 60
      • BUN increase > 5 even after IV fluids
      • base deficit > 4 (5 for gallstone)
      • fluid sequestration > 6 L (4 for gallstone)
    • interpretation
      • 1 point each. Severe pancreatitis likely if score >= 3
      • 0-2: 2% mortality
      • 3-4: 15% mortality
      • 5-6: 40% mortality
      • 7-8: 100% mortality
  • Discharge

    • criteria: tolerating PO
    • education: EtOH cessation

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