Standard Supportive Measures for Mild Pancreatitis

Intravenous fluid and electrolyte therapy is the cornerstone of supportive care in mild acute pancreatitis. 1

Initial Management

Fluid resuscitation with intravenous crystalloids or colloids is essential to maintain adequate urine output (>0.5 ml/kg body weight) 1
Oxygen supplementation should be administered to maintain arterial saturation greater than 95%, with continuous oxygen saturation monitoring 1
Pain control with appropriate analgesics is crucial - withholding analgesics to allow serial abdominal examinations is NOT recommended as this would compromise patient comfort and potentially worsen outcomes 1, 2
Basic monitoring of temperature, pulse, blood pressure, and urine output should be implemented 1

In mild pancreatitis, oral food intake should be tried as soon as pain ceases and pancreatic enzyme levels are decreasing 1
Enteral nutrition within five to seven days has no positive impact on the course of mild disease and is therefore not routinely recommended 1
When refeeding, start with a diet rich in carbohydrates and protein but low in fat (<30% of total energy intake) 1
If oral nutrition is not possible due to persistent pain for more than five days, tube feeding should be considered 1

Antibiotics should NOT be administered routinely in mild pancreatitis 1
Antibiotics are only warranted when specific infections occur (chest, urinary tract, biliary, or cannula-related) 1

Nasogastric decompression is NOT routinely required for mild pancreatitis 1
A nasogastric tube may be placed in select cases with significant nausea and vomiting, but is not a standard measure for all patients 1

Routine CT scanning is unnecessary unless there are clinical signs of deterioration 1
Abdominal ultrasound should be performed to look for gallstones and should be repeated if initially negative 1

Avoid massive antibiotic prophylaxis in mild pancreatitis as it provides no benefit and may lead to antibiotic resistance 1
Percutaneous drainage is NOT indicated for mild pancreatitis without complications 1
Avoid withholding analgesics for serial abdominal examinations as this compromises patient comfort without clinical benefit 2
Avoid overaggressive fluid resuscitation as recent studies suggest it may not improve outcomes in all patients with mild pancreatitis 3

For patients with gallstone pancreatitis, early ERCP (within 72 hours) should be performed only if there is a high suspicion of persistent common bile duct stone or cholangitis 1
Definitive surgical management (cholecystectomy) should be performed during the same hospital admission for gallstone pancreatitis if possible 1
Lactated Ringer's solution is the preferred fluid type for resuscitation based on clinical trials and meta-analyses 4