From the Guidelines
The mainstay of treatment for simple uncomplicated pancreatitis requiring short hospital admission is conservative intravenous hydration, adequate pain control, and bowel rest. According to the most recent and highest quality study 1, aggressive intravenous hydration is not recommended for patients with non-severe acute pancreatitis, as it may increase the risk of fluid overload without improving clinical conditions. Instead, a conservative approach to intravenous hydration should be taken, with fluids administered as needed to maintain adequate hydration and perfusion.
Pain management is a critical component of treatment, with opioid analgesics such as morphine or hydromorphone commonly used to control pain 1. The choice of analgesic and method of administration should be guided by current acute pain management guidelines. Patients should be kept NPO initially to rest the pancreas, with oral intake gradually reintroduced as symptoms improve. Antiemetics may be needed to control nausea.
Key components of treatment include:
- Conservative intravenous hydration to maintain pancreatic microcirculation
- Adequate pain control with opioid analgesics
- Bowel rest to reduce pancreatic stimulation
- Gradual reintroduction of oral intake as symptoms improve
- Antiemetics as needed to control nausea
This approach prioritizes the reduction of morbidity, mortality, and improvement of quality of life, and is supported by the most recent and highest quality evidence 1.
From the Research
Treatment Overview
The mainstay of simple uncomplicated pancreatitis treatment requiring short hospital admission for pain control and hydration involves:
- Fluid therapy as the cornerstone of managing acute pancreatitis 2
- Focus on fluid resuscitation, with some data to support Ringer's lactate over physiological saline 3
- Early oral feeding should be encouraged, not avoided, and use of parenteral nutrition is discouraged 3
- Avoiding total parenteral nutrition and prophylactic antibiotics, avoiding overly aggressive fluid resuscitation 4
Fluid Resuscitation
- Moderate fluid replacement is recommended over aggressive fluid resuscitation, as it is associated with lower mortality 5
- Lactated Ringer's solution is associated with an anti-inflammatory effect in patients with acute pancreatitis 6
- Lactated Ringer's solution may be preferred over normal saline due to its anti-inflammatory effects 6