Practice Based Learning: Management of acute pancreatitis

Lyndsi Paumen MD

 

 

 

 

Presented by Lyndsi Paumen MD (PGY1)

Traditional management of mild acute pancreatitis:

  • NPO (with IVFs, Jejunal feeds, or TPN) – “Rest the Pancreas”
    • Rationale: food in duodenum → cholecystokinin release → pancreatic enzyme secretion
    • Activation of proteolytic enzymes → autodigestion/tissue injury

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EBM Review: The Pediatric Intravenous Maintenance Solution study (PIMS): a randomised controlled double-blind trial.

McNab S, Duke T, South M, et al. 140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial. Lancet. 2014 Nov 28.

BACKGROUND: Use of hypotonic intravenous fluid to maintain hydration in children in hospital has been associated with hyponatraemia, leading to neurological morbidity and mortality. We aimed to assess whether use of fluid solutions with a higher sodium concentration reduced the risk of hyponatraemia compared with use of hypotonic solutions.

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Practice Based Learning: Is oral rehydration therapy an effective alternative to IV rehydration therapy in children?

Lajja Desai MD

Presented by Lajja Desai, MD

Key points:

PBL chart

Bottom Line:

1.    Oral rehydration therapy should be the first course of treatment for mild and moderate dehydration in children with AGE.
2.    Oral rehydration therapy can be initiated quicker than IV therapy in the ED setting. Can lead to shorter hospital stays and lower admission rates.
3.    Oral rehydration therapy can be utilized in “high risk groups”: moderate dehydration, children < 3 years of age.

References:

Arcara K and Tschudy M. The Harriet Lane Handbook, 19e. 2001.

Bellemare S, et al. Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomized controlled trials. BMC Medicine 2004, 2:11.

Harding L, et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children (Review). Cochrane Database of Systematic Reviews 2006, Issue 3. Art No: CD0004390.

Huang, LH, et al. Dehydration treatment and management. Medscape. March 12, 2012.

Spandorfer PR, et al. Oral versus intravenous rehydration of moderately dehydrated child: a randomized, controlled trial. Pediatrics 2005; 115;295.