Acute pancreatitis: recognition and monitoring
Severe epigastric pain radiating straight through to the back, worse lying flat and relieved by leaning forward or curling up, with nausea and vomiting. The position the client adopts is itself a clinical sign. The two usual causes are gallstones and alcohol. Ask about both, and about recent medications and triglyceride levels. Laboratory picture: lipase raised well above the reference range is the most useful test. Follow the calcium, which falls, the glucose, which rises, and the kidney function. The early treatment is fluid, analgesia and rest of the digestive tract. Fluid resuscitation in the first hours is what most changes the outcome, so the intake and output record is a treatment tool and not paperwork. Report a urine output below the threshold set. Monitor for the complications: persistent tachycardia and hypotension from third spacing, respiratory deterioration, fever, and a falling calcium with paresthesia or cramps. Analgesia is given and titrated; unrelieved pain in pancreatitis is not a sign of stoicism to be admired but a reason to reassess. At discharge, teach the cause: complete alcohol abstinence when alcohol is implicated, and follow-up for the gallstones when they are.