Acute pancreatitis kills through third-space fluid loss and organ failure, not through the enzyme number. Walk this admission hour by hour, decide the moment you stop titrating and start calling, and then see exactly what each hour of hesitation cost. Then move to the enzyme bench and build a chronic-pancreatitis routine that actually works.
Mr Hollis, 54, 80 kg. Admitted four hours ago with gallstone pancreatitis. Epigastric pain boring straight through to the back, worse supine, relieved by curling forward. Lipase 1,240 U/L (normal roughly 0 to 160), ALT 210 U/L, calcium 8.4 mg/dL. Lactated Ringer’s is running at 5 to 10 mL/kg/hr and he has a morphine PCA. You have him for the next twelve hours.
Hour
0
Baseline set of observations
Urine output goal for an 80 kg patient: at least 40 mL/hr (0.5 mL/kg/hr)
Mr Ferreira, 61, chronic pancreatitis from years of alcohol use. He has lost 9 kg in four months and describes bulky, greasy, foul-smelling stools that float and are hard to flush. Pancreatic enzyme replacement therapy has been prescribed. Build his routine.