Question about pancreatitis

[Cadet133]

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Wanted your opinions on your management. If you have someone come in with mild pancreatitis unknown etiology (full work up normal) with no abnormal labs other than the lipase being >5000. Vitals stable. APACHE II on admission 3. And patient wants to eat the next day with pain improved despite lipase being still >5000. Would you initiate early refeeding or would you wait a while?

 

[mszzeta]

Yes I would give pt food as soon as they are able to tolerate , and this is supported by extensive body of evidence and guidelines

The lipase level only helps for diagnostic purpose and totally useless regarding guiding when to eat

 

[jdh71]

Force cheeseburgers

 

[Shabeer]

Force cheeseburgers

Parenteral, right?

 

[jdh71]

Parenteral, right?

It’s preferable

 

[Cadet133]

Thought the same but uptodate seems to prefer for lipase to be going down

 

[obiwan]

Thought the same but uptodate seems to prefer for lipase to be going down

I sometimes wonder if we rely on UTD too much 🤔

And yes, I would let them eat something

 

[jdh71]

Thought the same but uptodate seems to prefer for lipase to be going down

I’ll be serious again. If I’ve got a pancreatitis that’s unexplained with a lipase that high and not coming down yet, I’m going to wait to do much feeding to. I do have a bias that is full of the worst cases and therefore I’m cautious about poking a skunk. Anecdotally, I have seen bad cases get worse after feeds - and it could be correlation not causation but . . .

 

[sluggs]

Pancreatitis: Pain control, fluids, feed!!

 

[aafisahar]

lipase elevation has nothing to do with severity. I've let pancreatitis patients with a lipase of 40,000 eat within 24 hours and I've had patients with a lipase level of 1000 crump on me and die.

Lipase is basically an on/off switch regarding pancreatitis. Either it adds to the diagnostic picture or it doesn't. The number doesn't really matter all much. There is zero utility in trending lipase levels.

 

[DoubleBogey]

lipase elevation has nothing to do with severity. I've let pancreatitis patients with a lipase of 40,000 eat within 24 hours and I've had patients with a lipase level of 1000 crump on me and die.

Lipase is basically an on/off switch regarding pancreatitis. Either it adds to the diagnostic picture or it doesn't. The number doesn't really matter all much. There is zero utility in trending lipase levels.

Similar to ammonia levels in cirrhotics

 

[Sushirolls]

... come in with mild pancreatitis unknown etiology (full work up normal)...

The scorpion stings again! /sarcasm

 

[Raryn]

Wanted your opinions on your management. If you have someone come in with mild pancreatitis unknown etiology (full work up normal) with no abnormal labs other than the lipase being >5000. Vitals stable. APACHE II on admission 3. And patient wants to eat the next day with pain improved despite lipase being still >5000. Would you initiate early refeeding or would you wait a while?

There is no good evidence for trending lipase. I would have checked it once on admission and then never checked it again - follow the patient clinically.

 

[IM2GI]

Similar to ammonia levels in cirrhotics

A one-time lipase is at least helpful in diagnosing acute pancreatitis. Ammonia level is irrelevant in nearly all cases and does not make the diagnosis of hepatic encephalopathy.

 

[aafisahar]

A one-time lipase is at least helpful in diagnosing acute pancreatitis. Ammonia level is irrelevant in nearly all cases and does not make the diagnosis of hepatic encephalopathy.

yep, if you flappin, you poopin, don't give a **** what the ammonia level is. I've seen normal ammonia levels in cirrhotics who were encephalopathic and they still get better with poopin

 

[Siggy]

lipase elevation has nothing to do with severity. I've let pancreatitis patients with a lipase of 40,000 eat within 24 hours and I've had patients with a lipase level of 1000 crump on me and die.

Lipase is basically an on/off switch regarding pancreatitis. Either it adds to the diagnostic picture or it doesn't. The number doesn't really matter all much. There is zero utility in trending lipase levels.

I'll trend lipase in gall stone panc patients because the surgeons will use the lack of an updated lipase level as an excuse to push the lap chole off a day or two (especially if it's coming up to a weekend). It's like liver failure patients, INRs, and procedures. Sometimes there's less harm in playing the game than refusing to play a game with terrible rules.