Pancreatitis complications

Grosse P, Rusch L, Schmitz B. Pancreatitis complicating treatment with intravenous valproate three case reports. Epilepsia 1999 40(Suppl. 2) 267. 

HUMAN HEALTH RISKS Acute Risks headaches vomiting drowsiness irritation of upper respiratory tract gastrointestinal irritation lesions of the mouth and esophagus pulmonary edema bums to mouth and throat pancreatic complications Chronic Risks Damage to liver, lungs, CNS, kidneys, blood. 

Depending on the nature of the compound, the ddN analogues have been associated with varying toxic side effects such as bone marrow suppression (AZT), pancreatitis (ddl), hypersensitivity reactions (ABC), and neurologic complications consequently to mitochondrial toxicity (ddC), while others, such as 3TC and (-)FTC, have few, if any, side effects. 

A patient with acute pancreatitis may develop many severe local and systemic complications. Local complications involve fluid collection, necrosis, or abscess in the pancreas. A pancreatic fluid collection (or pancreatic pseudocyst) is a collection of tissue, pancreatic enzymes, and blood that forms weeks after acute pancreatitis. Many pancreatic pseudocysts resolve spontaneously, but some require surgical drainage.5 Rupture of a pancreatic pseudocyst with associated erosion and hemorrhage of major abdominal blood vessels can have a mortality approaching 60% thus, continued monitoring of a pseudocyst is prudent.6... 

It is common practice to discontinue oral feedings during an attack of acute pancreatitis. In theory, discontinuation of oral intake will decrease the secretory functions of the pancreas and minimize further complications from the disease. Some patients can be fed with minimal oral intake. Tube feeding delivered via a nasojejunal tube will feed the patient beyond the ampulla of Vater, minimizing stimulation of the pancreas.15,16 If oral intake is discontinued for a protracted period, total parenteral nutrition must be used to maintain adequate nutrition.17,18... 

Intravenous lipid emulsions are also a source of calories. The typical daily dose in adults is approximately 0.5 to 1 g/kg per day. In the absence of hypertriglyceridemia, substituting a portion of dextrose calories with lipid calories may be beneficial in situations where dextrose infusion may lead to complications (e.g., hyperglycemia). Some examples include patients with diabetes mellitus or pancreatic disease and patients under severe stress (e.g., trauma or burns) who are at risk for hyperglycemia. The maximum of dose of lipid emulsions is 2.5 g/kg per day,7 or 60% of total daily calories, although doses this high are used rarely in practice. 

Traditionally, glucagon preparations utilized therapeutically are chromatographically purified from bovine or porcine pancreatic tissue. (The structure of bovine, porcine and human glucagon is identical, thus eliminating the possibility of direct immunological complications). Such commercial preparations are generally formulated with lactose and sodium chloride and sold in freeze-dried form. Glucagon, 0.5-1.0 units (approximately 0.5-1.0 mg freeze-dried hormone), is administered to the patient by s.c. or i.m. injection. 

Local complications in severe AP may include acute fluid collection, pancreatic necrosis, abscess, pseudocyst formation, and pancreatic ascites. 

Clinical signs associated with widespread pancreatic inflammation and necrosis include marked epigastric tenderness, abdominal distention, hypotension, and low-grade fever. In severe disease, bowel sounds are diminished or absent. Dyspnea and tachypnea are signs of acute respiratory complications. 

Treatment of AP is aimed at relieving abdominal pain and nausea, replacing fluids, minimizing systemic complications, and preventing pancreatic necrosis and infection. 

Patients predicted to follow a severe course require treatment of any cardiovascular, respiratory, renal, and metabolic complications. Aggressive fluid resuscitation is essential to correct intravascular volume depletion and maintain blood pressure. IV colloids may be required because fluid losses are rich in protein. Drotrecogin alfa may benefit patients with pancreatitis and systemic inflammatory response syndrome. IV potassium, calcium, and magnesium are used to correct deficiency states. Insulin is used to treat hyperglycemia. Patients with necrotizing pancreatitis may require antibiotics and surgical intervention. 

Malabsorption of protein and fat occurs when the capacity for enzyme secretion is reduced by 90%. A minority of patients develop complications including pancreatic pseudocyst, abscess, and ascites or common bile duct obstruction leading to cholangitis or secondary biliary cirrhosis. 

Familial hyperlipoproteinemia Estrogen therapy may be associated with massive elevations of plasma triglycerides leading to pancreatitis and other complications in patients with familial defects of lipoprotein metabolism. 

Pancreatitis Pancreatitis, fatal in some cases, has been observed with zalcitabine administration. Pancreatitis is an uncommon complication of zalcitabine therapy, occurring in up to 1.1% of patients. 

Didanosine (2 3 -dideoxyinosine or ddl) is a dideoxynucleoside purine analogue. Its mechanism of action is identical to that of zidovudine and resistance to didanosine is known to occur rapidly in patients who were already treated with zidovudine. Didanosine shows in vitro synergy with zidovudine while their toxicity profiles are different. Oral absorption is decreased by food and didanoside penetrates into the brain to a limited extend. Pancreatitis is the most serious complication. Other adverse reactions include peripheral neuropathy, diarrhoea and other gastrointestinal disturbances. 

Incidence of acute pancreatitis is steadily rising from year to year and according to world statistics, varies from 200 to 800 patients per million of population [1]. Some 15-20% of patients experience destructive, necrotic progression of acute pancreatitis [1,2]. Early toxemic and late septic complications of destructive pancreatitis are stiU... 

Serious medical complications (e.g., pancreatitis, gastrointestinal bleeding, hepatitis, cirrhosis, or pneumonia)... 

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