Pancreatitis, Acute
Description General Measures Medicine Treatment Referral ICD-10 code: K85.0-3/K85.8-9 DESCRIPTION Acute inflammatory condition of the pancreas. Acute pancreatitis is based on the fulfulment of '2 out of 3' of the following criteria: clinical (upper abdominal pain), laboratory (serum amylase or lipase >3x upper limit of normal), and/or imaging (CT, MRI, ultrasonography) criteria. Intense local
ICD-10 code: K85.0-3/K85.8-9
DESCRIPTION
Acute inflammatory condition of the pancreas.
Acute pancreatitis is based on the fulfulment of '2 out of 3' of the following criteria:
- clinical (upper abdominal pain),
- laboratory (serum amylase or lipase >3x upper limit of normal), and/or
- imaging (CT, MRI, ultrasonography) criteria.
Intense local inflammation results in pain, and local as well as systemic, complications. Disseminated intravascular coagulopathy (DIC), metabolic derangements and shock may occur.
Measurement of renal function and electrolytes measurements (including calcium) can be used to determine severity.
GENERAL MEASURES
- Parenteral fluid replacement to correct metabolic and electrolyte disturbances.
- Parenteral nutrition is associated with adverse outcomes and should only be considered in patients that cannot receive or tolerate nasogastric or enteral nutrition.
- Drainage of abscess/pseudocyst, if required.
MEDICINE TREATMENT
Pain:
- Morphine, IV, to a total maximum dose of 10 mg (See Appendix II, for individual dosing and monitoring for response and toxicity).
Acute symptomatic hypocalcaemia:
ICD-10 code: E83.5
- Calcium gluconate 10%, IV infusion, 10 mL as a bolus over 10 minutes.
- Follow with 60–120 mL diluted in 1 L sodium chloride 0.9%, administered over 12–24 hours.
- Monitor serum calcium at least 12 hourly.
If serum magnesium < 0.5 mmol/L:
ADD
- Magnesium sulphate, IV infusion, 25–50 mmol in 12–24 hours.
- 1 mL magnesium sulphate 50% = 2 mmol magnesium.
Antimicrobial therapy
Routine administration of prophylactic antibiotics are not necessary.
For infected necrosis of the pancreas:
Broad spectrum IV antibiotics:
- Amoxicillin/clavulanic acid, IV, 1.2 g 8 hourly for 10 days, depending on clinical response.
REFERRAL
Severe complications, e.g. necrosis; haemorrhagic or systemic complications; or infective pancreatitis.
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_July 2024
Chapter 1: Alimentary tract; 1.1 Gastrointestinal Disorders; 1.1.6 Pancreatitis, Acute