Remember the common (and not so common) causes of pancreatitis (I GET SMASHED):

Idiopathic

Gallstones
ETOH
Trauma

Steroids
Mumps
Autoimmune
Scorpion stings (species found on the island of Trinidad)
HyperTG/Ca2+
ERCPs
Drugs
* Gallstones and alcohol account for approximately 80% of all cases in the US

Diagnosis of pancreatitis (requires 2 of 3):

1. Typical clinical symptoms
2. Elevated Lipase > 3 x the ULN
3. Imaging findings consistent with pancreatitis

Clinical predictors of worse prognosis:

• Older age (usually 55-75 years old)
• Alcohol – increased risk for pancreatic necrosis and need for intubation
• Obesity (BMI > 30) OR 2.9
• Multiple medical co-morbidities

Management Principles:

1. Fluid Replacement
   • 5-10 mL/kg/hr of isotonic crystalloid solution unless contraindicated 
   • Avoid LR in patients with hypercalcemia since it contains calcium
   • Re-evaluate frequently in the first 6 hours and adjust rate as necessary
2. Pain Management
   • Typically IV opiates in PCA form
   • Dilaudid/fentanyl are good choices; morphine has been shown to increase sphincter of Oddi pressure, but no studies exist to suggest worse outcomes
3. Nutrition
   • Oral feeds can be resumed in mild pancreatitis as soon as pain controlled/patient hungry
   • Enteral feeds are preferred over parental feeds; place NJ tube beyond ligament of Trietz if possible – but NG preferred to NPO
4. Antibiotics
   • prophylactic antibiotics are not recommended regardless of the type (interstitial/narcotizing) or severity (mild/moderate/severe)