Management of severe pancreatitis has remained in a state of controlled chaos and persistent debate for years (mirroring evolution in our treatment of septic shock). This confusion shows no signs of abating in the near future. This chapter explores a reasonable approach to pancreatitis, with the caveat that there is very little evidence available to guide our combat against this challenging foe.
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The IBCC chapter is located here.
- The podcast & comments are below.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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In my hospital in Broome, Australia, we see huge numbers of Aboriginal people with recurrent, acute alcoholic pancreatitis. They are unhappy, but NEVER really sick. This almost seems like a different illness to the severe, ‘hypotensive, sepsis-like, ICU’ pancreatitis.
Great episode as always, really appreciate you putting these together.
What are your thoughts on calcium repletion in acute pancreatitis? It is not unusual for me to see patients with an ionized calcium level down in the 0.6-0.7 range, however dumping grams and grams of calcium in makes me concerned about causing acinar injury or damage from the saponification. I have looked and realy can’t see too many recommendations on this.
Thanks for another outstanding post, the whole IBCC is a game-changer.
I’m very much on board with a more fluid restrictive approach to pancreatic and similar inflammatory conditions for all the reasons you guys already talked about, but looking at the first citation (Mao E, Tang Y, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl). 2009;122(2):169-173.) they cite decreases in ACS/ARDS etc, but then also noted significantly increased mortality in the low fluids group. Was wondering if you had any particular insight to reconcile the odd discrepancy.
“Survival rate was remarkably lower in Group I (69.4%) than in Group II (90%, P < 0.05)." Not sure where the discrepancy lies? Survival was higher in the controlled fluid group. .
I note the phrase “aggressive fluid resuscitation can cause ARDS” appears twice in this excellent post. Perhaps the wording should be adjusted to “worsen or exacerbate” rather than “cause”.