• 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

Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
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.