Management Plan
As we have discussed, it is difficult to know initially which patients will go on to develop complications of pancreatitis and therefore it would be wise to treat all patients aggressively until severity has been established since simple measures may be associated with resolution of organ failure [8]. Aim for SaO2 >95% and a urine output of >0.5 ml/kg.
The management plan involves:
- Resuscitate – if dehydrated or signs of sepsis
- Oxygen – high flow through variable delivery mask
- Intravenous access x2
- IV normal saline 1-2 L then reassess (may require several litres of fluid resuscitation)
- Analgesia – opiate titrated to effect with an antiemetic
- Keep nil-by-mouth with the placement of an NG tube only if there is evidence of an ileus
- Urinary catheter and hourly urine volumes
- IV broad spectrum antibiotics only if signs of sepsis
- Involve surgical team and admit ALL patients with suspected pancreatitis
Emerging treatments
Gastric antisecretory agents
H2 antagonists and proton pump inhibitors may have a role in the treatment of acute pancreatitis by decreasing pancreatic stimulation; however, more research is needed.
CM4620
CM4620, a novel calcium release-activated calcium channel inhibitor for the treatment of acute pancreatitis, has received fast-track designation from the US Food and Drug Administration and orphan designation from the European Medicines Agency. CM4620 is expected to reduce cell damage and death in the pancreas, thereby minimising symptoms.