Treatment for Mild Pancreatitis
The treatment for mild pancreatitis involves supportive care on a general ward with monitoring of vital signs, adequate fluid resuscitation with Lactated Ringer's solution, pain management, and advancement of diet as tolerated, without routine antibiotic use. 1, 2
Initial Assessment and Management
- Mild pancreatitis accounts for approximately 80% of cases and less than 5% of deaths from the disease 1
- Patients can be managed on a general ward with basic monitoring of temperature, pulse, blood pressure, and urine output 2
- Peripheral intravenous access is required for fluid administration, and some patients may need a nasogastric tube, but few will require an indwelling urinary catheter 3
- Oxygen saturation should be continuously monitored with supplemental oxygen to maintain arterial saturation >95% 1
Fluid Resuscitation
- Moderate fluid resuscitation is preferred over aggressive resuscitation based on recent evidence 4
- Lactated Ringer's solution is superior to normal saline for fluid resuscitation as it reduces systemic inflammation compared to normal saline 5
- A reasonable approach includes a 10 ml/kg bolus followed by 1.5 ml/kg/hr maintenance rate 6
- Regular monitoring of fluid status and response is essential to avoid both under-resuscitation and fluid overload 4
Pain Management
- Pain control is a clinical priority in acute pancreatitis 7
- Analgesics should be administered as needed, with no evidence supporting restrictions in pain medication 7
- Patient-controlled analgesia (PCA) should be integrated with the pain management strategy 7
Nutritional Support
- Regular diet can be advanced as tolerated with appropriate pain management 1
- Early oral feeding is recommended as soon as pain and nausea allow 2
- There is no need to wait for complete normalization of pancreatic enzymes before reintroducing oral feeding 1
Antibiotic Use
- Antibiotics should NOT be administered routinely in mild pancreatitis as there is no evidence that their use will affect outcomes or reduce septic complications 3, 2
- Antibiotics are warranted only when specific infections occur (chest, urine, bile, or cannula related) 3
Imaging
- Routine CT scanning is unnecessary unless there are clinical signs of deterioration 3, 1
- Early ultrasound scanning should be performed to check for gallstones and should be repeated if negative 3
Management of Gallstone Pancreatitis
- In mild gallstone pancreatitis without jaundice or dilated common bile duct, ERCP is not necessarily recommended 3
- ERCP is indicated in the presence of jaundice, cholangitis, or a dilated common bile duct 3, 1
- All patients with biliary pancreatitis should undergo definitive management of gallstones during the same hospital admission, unless a clear plan has been made for treatment within two weeks 1
Monitoring and Follow-up
- Regular monitoring of vital signs and laboratory parameters is essential 2
- Clinical improvement should be assessed at regular intervals 8
- The majority of mild pancreatitis cases will resolve with supportive care within 3-7 days 1