There are no surprises in a recent clinical report on acute pancreatitis (M Abu-El-Haija et al. JPGN 2018: 66: 159-76) from NASPGHAN.
Here are a few of the points:
- The authors recommend ultrasound for initial imaging and checking liver enzymes, GGT, calcium and triglycerides.
- For fluids, they indicate that in adults there is evidence suggesting that lactated ringer’s (LR) is likely preferable to normal saline. In children, on presentation, “if evidence of hemodynamic compromise, a bolus of 10 to 20 mL/kg” of crystalloid is recommended followed by “1.5 to 2 times maintenance IV fluids.”
- For pain management not responding to acetaminophen or NSAIDs, “IV morphine or other opioids should be used.”
- They recommend early oral/enteral nutrition (within 48 to 72 hours of presentation).
- They recommend against prophylactic antibiotics in severe acute pancreatitis.
- They recommend against probiotics, anti-proteases, and antioxidant therapy.
- For fluid collections that need drainage or necrosectomy, nonsurgical approaches are favored.
- Acute biliary pancreatitis, “Cholecystectomy safely can and should be performed before discharge in cases of mild uncomplicated acute biliary pancreatitis.”
Related blog posts:
- Acute Pancreatitis Review (2016)
- For the pediatric pancreatologists
- Pancreatitis Update (part 1) | gutsandgrowth 2017
- Pancreatitis Update (part 2) 2017
- Changing Practice Patterns with Pediatric Pancreatitis | gutsandgrowth
- Why an ERCP Study Matters to Pediatric Care | gutsandgrowth This post explains why LR may be best.
- Nutrition University / gutsandgrowth