Severe acute pancreatitis (SAP) is a life-threatening form of pancreatitis, with up to 30% mortality.
SAP may lead to hypovolemic shock (secondary to vasodilation and capillary leak), hypoxemia (from acute respiratory distress syndrome), and multi-organ failure.
Suspect SAP with signs and symptoms of pancreatitis plus any of the following:
Hypotension
Hypoxemia
Elevated hematocrit (secondary to hemoconcentration)
Metabolic acidosis
Decreased ionized calcium
Treatment of SAP should focus on:
Hemodynamic support including intravascular volume repletion
Respiratory support to correct hypoxemia
Screening for abdominal compartment syndrome (risk increased with SAP)
Prophylactic antibiotics are not recommended
References
Greer, S. E., & Burchard, K. W. (2009). Acute pancreatitis and critical illness: a pancreatic tale of hypoperfusion and inflammation. Chest, 136(5), 1413–1419.
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