Treatment-acute pancreatitis

• Fluid resusc.: aggressive in 1st 24 hrs, even if mild. 20 mL/kg IVB → 3 mL/kg/hr. Goal ↓ BUN & Hct over 12–24 h. ✓ UOP (goal 0.5–1 cc/kg/hr); LR superior to NS (↓ SIRS; avoid if ↑ Ca).

• Nutrition (NEJM 2014;317:1983) Early versus on-demand nasoenteric tube feeding in acute pancreatitis - PubMed

Early enteral feeding encouraged, though not superior to oral feeding at 72 h

Mild: Start feeding once without N/V or ileus; may not need to be completely pain free. Low-fat low-residue diet as safe as liquid diet and a/w shorter LOS.

Severe: early (w/in 48–72 h) enteral nutrition indicated and preferred over TPN b/c ↓ infectious complications. Nasogastric non-inferior to nasojejunal feeding.

• Analgesia: IV opioids (monitor respiratory status, adjust dosing if ↑ renal impairment)

• Gallstone pancreatitis: urgent (w/in 24 h) ERCP w/ sphincterotomy if cholangitis, sepsis, or Tbili ≥5. If mild, CCY during initial hosp. to ↓ risk of recurrence (Lancet 2015;386:1261); defer surgery if necrotizing panc. until improvement in inflam. & fluid collections.

詳見Same-admission versus interval cholecystectomy for mild gallstone pancreatitis

• Hypertriglyceridemia: insulin gtt (activates lipoprotein lipase), fibrates, ± apheresis

• No role for Ppx abx in absence of infectious complications (World J Gastro 2012;18:279)