• Acute Pancreatitis:
  • Data suggests LR better than NS.
  • Initial resuscitation 5-10ml/kg/hr -> about 2.5L-4L in first 24hrs. 
  
  

  Posted 02/16/17 10:40:18 AM by Adam Faye

• NEJM Pancreatitis Review Article:
  • Degree of amylase/lipase has NO prognostic value
  • Studies have looked at CT as predictive factors; imaging lags behind clinical findings so early CT can underestimate the severity of the disorder
  • Some use Hematocrit- if rising even after fludi administration may implicate more severe pancreatitis
  
  

  Posted 02/16/17 10:42:57 AM by Adam Faye

• Pancreatitis ABx:
  • Usually takes about 2 weeks after pancreatitis to become necrotic
  • Multiple studies now showing that prophylactic Abx do not prevent sterile necrosis from being infected. Treat id suspected/confirmed - usually with a carbepenem
  
  

  Posted 02/16/17 11:18:55 AM by Adam Faye

• Pancreatitis - when to allow PO intake?
  • Mild pancreatitis with no organ failure/necrosis - no need for complete resolution of pain/normalization of pancreatic enzyme levels before oral feeding is started.
  • For more severe pancreatitis; Randomized to 24hrs. vs. 72hrs. to start feeding- early feeding (24hrs) did not improve outcomes.
  • Nasojejunal vs. Nasogastric feeding; Nasojejunal has the benefit of minimizing pancreatic secretions but no sig. mortality/outcome difference. 
  
  

  Posted 02/16/17 11:48:55 AM by Adam Faye

• C. diff
  • Data for high dose PO Vanc is minimal- no clear benefit but often done.
  • Ne NEJM article looking at Bezoltoxomab: 2,655 patients receiving PO Abx for C. diff (Primary or Recurrent)
    • Bezlotoxumab vs. (Bezlotoxumab + Actoxumab) vs. Placebo
    • Primary End point: Recurrent Infection
    • Bezlotoxumab- 16% vs. Placebo 26%
    • Adding Actoxumab did not reduce recurrent infection risk 
  
  
  • **Bezlotoxumab inhibits one doman of C. diff Toxin B**
  
  

  Posted 02/16/17 11:50:45 AM by Adam Faye

Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.