Acute pancreatitis therapy

Primary therapy for acute pancreatitis is supportive, with fluid repletion, discontinuation of oral intake, and analgesia. 

Many medications can precipitate an attack of acute pancreatitis. If a medication is determined to be the cause of acute pancreatitis, it should be discontinued and alternative therapy considered.13,14... 

Pain management is an important component of therapy and is similar to that of acute pancreatitis. Non-opioid analgesics are preferred, but the severe and persistent nature of the pain often requires opioid therapy. Patients can require chronic doses of opioid analgesics, with a resulting risk of addiction. Pain can also be managed by removing the stimulus of exacerbation if identified.31,38... 

Hamed I, Lindeman RD, Czerwinski AW. Case report acute pancreatitis following corticosteroid and azathiopr-ine therapy. Am J Med Sci 1978 276(2) 211-9. 

There is a small but significant risk of acute pancreatitis at 2-78 weeks after the start of hormone replacement therapy the pain usually abates within 10 days of withdrawal (50). 

The temporal association with carbimazole therapy, the response to rechallenge, and the absence of other causes of acute pancreatitis suggested that the drug was causative in this case. 

Belaiche G, Ley G, Slama JL. Pancreatite aigue associee a la prise d atorvastatine. [Acute pancreatitis associated with atorvastatine therapy.] Gastroenterol Clin Biol 2000 24(4) 471-2. 

According to the authors, statin-induced acute pancreatitis can occur on the first day of therapy or after several months. It is generally mild and runs a benign course no deaths have been reported. Its frequency is unknown but it is probably rare. 

Tysk C, Al-Eryani AY, Shawabkeh AA. Acute pancreatitis induced by fluvastatin therapy. J Clin Gastroenterol 2002 35(5) 406-8. 

Pezzilli R, Ceciliato R, Corinaldesi R, Barakat B. Acute pancreatitis due to simvastatin therapy increased severity after rechallenge. Dig Liver Dis 2004 36(9) 639-40. 

Acute pancreatitis is usually a self-limiting disease, which regresses spontaneously without further complications. However, in about 20% of cases it leads to organ failure and/or local complications and is associated with high morbidity and mortality rates (B15). Therefore, numerous attempts have been made to predict early the severe course of acute pancreatitis and to assess the possibility of complications. Objective identification of the risk of complications or death is essential for selection of those patients who should be hospitalized in the intensive care unit (ICU) and be subjected to more expensive and aggressive investigations. Moreover, it also permits interinstitutional comparison of data stratified for severity at admission and at the time of therapy. 

B23. Biichler, M. W., Uhl, W., and Friess, H., Acute Pancreatitis. Novel Concepts in Biology and Therapy. Blackwell, Berlin, 1999. 

L7. Larvin, M., Wilson, C., and Heath, D., A prospective, multicenter, randomized trial of intraperi-toneal antiprotease therapy for acute pancreatitis. Gastroenterology 112,274A (1992). 

Chandhari, S., Park, J., Anand, B.S., Pimstone, N.R., Dieterich, D.T., Batash, S., Binl, E.J. Acute pancreatitis associated with interferon and ribavirin therapy in patients with chronic hepatitis C. Dig. Dis. Sci. 2004 49 1000-1006... 

Acute pancreatitis has been described after high-dose bolus aldesleukin therapy (83). 

Paul AC, Oommen SP, Angami S, Moses PD. Acute pancreatitis in a child with idiopathic ulcerative colitis on longterm 5-aminosalicylic acid therapy. Indian J Gastroenterol 2000 19(4) 195-6. 

Fernandez J, Sala M, Panes J, Feu F, Navarro S, Teres J. Acute pancreatitis after long-term 5-aminosalicylic acid therapy. Am J Gastroenterol 1997 92(12) 2302-3. 

A 42-year-old Asian man developed clinical, biochemical, and imaging features of acute pancreatitis 11 days after starting to take rifampicin, isoniazid, and pyrazi-namide for spinal tuberculosis (33). He had no history of excessive alcohol or other drug therapy. He improved after withdrawal of all drugs, but the pancreatitis recurred on reintroduction of isoniazid and resolved after withdrawal. 

A healthy 21-year-old woman developed acute pancreatitis a day after an anesthetic that lasted 138 minutes, with propofol for induction (66). She recovered after supportive therapy for 6 days. There was no evidence of gallstones on abdominal imaging and there was no defect in lipid metabolism. 

Yutsudo Y, Imoto S, Ozuru R, Kajimoto K, Itoi H, Koizumi T, Nishimura R, Nakagawa T. Acute pancreatitis after all-trans retinoic acid therapy. Ann Hematol 1997 74(6) 295-6. 

Izaeli S, Adamson PC, Blaney SM, et al. Acute pancreatitis after ifos- 45. famide therapy. Cancer 1994 74 1627-1628. 

AndriulU A, Leandro G, Qemente R, et al. Meta-analysis of somatostatin, octreotide and gabexate mesilate in the therapy of acute pancreatitis. Aliment Pharmacol Ther 1998 12 237-245. 

Kuklinski B, Zimmermann T and Schweder R (1995) Decreasing mortality in acute pancreatitis with sodium selenite. Clinical results of 4 years antioxidant therapy. Med Klinik 90 Suppl 1 36—... 

Kanbay M, SekukH, YilmazU, Gur G, BoyaciogluS. Acute pancreatitis associated with combined Usinopril and atorvastatin therapy. DigDis (2005) 23,92-4. 

Tuon FF, Guastini CM, Boulos MI. Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis. Braz J Infect Dis 2008 12(4) 263. 

Chen JL, Spinowitz N, Karwa M. Hypertriglyceridemia, acute pancreatitis, and diabetic ketoacidosis possibly associated with mirtazapine therapy a case report. Pharmacotherapy 2003 23(7) 940-A. 

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