35-year-old man presenting with acute pancreatitis- Ideal fluid of choice
Ans. (a) Isotonic CrystalloidRef: Sabiston 20th ed; pg. 1528Management of Acute pancreatitis:* Corner stone of medical management is resuscitation with IV fluids - ISOTONIC CRYSTALLOIDS are given aggressively.* Monitor the adequacy of resuscitation with urine output.* If there is no response to fluid resuscitation - Invasive monitoring to be done using CVP access and Foley catheterization.* MC complication in acute pancreatitis is Hypoxemia due to Acute lung injury and hence maintain Saturation above 95%- Continuous Pulse oximetry monitoring is needed.* Preferred analgesia- morphine narcotics* No proven benefit of giving Antiproteases and Pancreas secretion inhibitors or platelet activation inhibitors (Lexipafant).Nutritional Support in Acute Pancreatitis:* Oral feeding may be difficult because of Ileus, pain and intubation.* 20% of severe acute pancreatitis will develop severe pain on oral feeding.* Enteral or Parenteral must be given though the mortality rate is same in both.* Enteral nutrition has one advantage - less infectious complication.* TPN causes Intestinal Colonization of bacteria, translocation and damage of mucosal defense mechanism.* Hence whenever possible give Enteral (Nasogastric feeding is better as per Bailey and Love page 1225/27th edition)* Prophylactic antibiotics have no role in acute pancreatitis and indicated only for pancreatic abscess, infected necrosis, cholangitis.Additional treatments:* If it is a case of Gallstone pancreatitis caused by Stones in CBD causing Cholangitis, Jaundice- ERCP must be done in 72 hours' time as per Bailey and Love.* Mild Acute Pancreatitis caused by Gallstones - EARLY laparoscopic Cholecystectomy (During same admission) is indicated except in poor performance cases like old age.* Severe Acute pancreatitis caused by Gall stones - conservative treatment for 6 weeks followed by Interval cholecystectomy after 6 weeks is advised.
Isotonic crystalloid
Hypertonic crystalloids
Hypotonic crystalloid
Vasopressin
Pancreas