Management Plan

Treatment for acute pancreatitis is supportive care. Adequate early fluid resuscitation is the single most important aspect in reducing organ failure and in-hospital mortality. The main goal of initial treatment is to provide symptomatic relief and prevent complications which is achieved by reducing pancreatic secretory stimuli and correction of fluid and electrolyte abnormalities. [8]

Patient should be fluid resuscitated and kept nil by mouth with bowel rest when nausea, vomiting or abdominal pain is present. [8]

Initial management plan involves [8]:

• Goal directed rehydration with Ringers lactate/hartmanns solution at rate of 5-10ml/kg/hr
• Optimise analgesia (e.g. Morphine) to prevent diaphragmatic splinting and other respiratory complications
• Oxygen therapy if signs of hypoxia
• Keep NBM
• Antiemetics
• Urinary catheter in severe acute pancreatitis to allow accurate monitoring of fluid balance
• Antibiotics reserved when infection is highly suspected or other concurrent infections suspected
• Involve surgical team and admit ALL patients with suspected pancreatitis.

Emerging treatments

Gastric antisecretory agents

H2 antagonists and proton pump inhibitors may have a role in the treatment of acute pancreatitis by decreasing pancreatic stimulation; however, more research is needed.

CM4620

CM4620, a novel calcium release-activated calcium channel inhibitor for the treatment of acute pancreatitis, has received fast-track designation from the US Food and Drug Administration and orphan designation from the European Medicines Agency. CM4620 is expected to reduce cell damage and death in the pancreas, thereby minimising symptoms.

Learning bite

NICE doesnt currently recommend prophylactic antimicrobials for acute pancreatitis as there is no clear evidence of benefit. [9]