A 30-year-old female with no past medical history presents to the emergency department complaining of severe abdominal pain after a night of binge drinking. She is noted to have a low-grade temperature of 100.4°F with the following vital signs:
On examination, she has focal moderate to severe tenderness in her mid-epigastrium without peritoneal signs. Her laboratory test results are notable for
An abdominal ultrasound shows no evidence of cholelithiasis. She is diagnosed with acute alcoholic pancreatitis and admitted to the hospital. All of the following are important initial steps in the management of moderate-severe acute pancreatitis EXCEPT:
A. Admission to a monitored hospital bedCorrect Answer: C
Acute pancreatitis is an inflammatory disease of the pancreas with a variety of etiologies but is most commonly caused by gallstones or alcohol use. The resultant systemic inflammatory response and potential resultant organ failure are currently used in the severity assessment of individual cases. Initial management of a patient presenting with moderate to severe acute pancreatitis involves admission to a monitored bed including consideration for admission to an ICU if appropriate, as well as initiation of isotonic crystalloid resuscitation with Lactated Ringer solution. CT at the time of initial presentation rarely alters management and thus is not required when the diagnosis is clear based on clinical and biochemical grounds. Early initiation of oral feeding is strongly recommended given multiple studies demonstrating the safety of early enteral feeding in addition to reduced rates of infectious complications, multisystem organ failure, and mortality. Current guidelines recommend against the use of prophylactic antibiotics. This is based on review of the literature including 10 randomized control trials that showed no difference in infectious outcomes or mortality.
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