5 acute pancreatitis drug minefields, 90% of doctors have stepped on the "thunder"!

For medical professionals only

Take stock of the 5 major irrational medications for acute pancreatitis, you may have also committed

Propofol

C.

D.

E.

Click on the blank space below to get the answer

Correct answer: A D

HTG-AP patients with fat lotion

HTG-AP patients with propofol

AP patient with atropine

Patients with HTG-AP should apply levofloxacin

Acute biliary pancreatitis (mild) with imipencistatin sodium
▌ Case: Gastroenterology, patient, female, 35 years old
.

Consult a doctor
for "17 hours of epigastric pain".
▌ Diagnosis: Acute biliary pancreatitis (mild).

▌ Prescription:
Imipenemcistatin sodium 0.
5g + 0.
9% sodium chloride injection 100ml, intravenous infusion, once every 8 hours
.
▌ Analysis: For suspected or confirmed pancreatic (peripancreatic) or extrapancreatic infections (such as biliary system, lungs, urinary system, catheter-related infections, etc.
), antimicrobials can be empirically used and antibacterial drugs
can be adjusted according to the susceptibility results.

Biliary pancreatitis is often associated with biliary tract infections, and third-generation cephalosporins can be used for gram-negative bacteria
.
AP secondary infection peaks in the 2nd to 4th week
after pancreatitis.

Antibiotics should be used in patients with acute cholangitis or confirmed extrapancreatic infection, and antibiotics should be given in case of signs of sepsis or if the bacteria are positive for puncture culture from a foci of infectious necrosis
.
Septic necrosis should be treated with antibiotics known to penetrate the necrotizing pancreas, and the antimicrobial spectrum includes aerobic and anaerobic gram-negative and gram-positive bacteria
.
Third-generation cephalosporins have a moderate osmotic effect on pancreatic tissue and can cover most gram-negative bacteria in pancreatic infections; Carbapenems have good permeability of pancreatic tissue, can cover anaerobic bacteria, and are only used in critically ill people; Quinolones such as ciprofloxacin and moxifloxacin have good pancreatic tissue permeability, can cover anaerobic bacteria, and are generally only used for people who are allergic to β-lactams; Metronidazole is anti-anaerobic and penetrates well into the pancreas
.

▌ Recommendation: Apply third-generation cephalosporins (such as ceftriaxone injection).

AP rational use of drug points

Patients with HTG-AP are contraindicated from the use of fatty milk within 72 hours of onset
.
In patients with HTG-AP, analgesic sedatives that can cause elevated lipids, such as propofol, should be avoided
.

Butorphanol tartrate has a high safety profile and can be used for analgesic sedation
in HTG-AP patients.
For patients with AP, cholinergic receptor antagonists such as atropine and scopolamine are not recommended because they can induce or aggravate intestinal paralysis
.
Prophylactic use of antimicrobials
is not recommended in AP patients with no evidence of infection.
Biliary pancreatitis is often associated with biliary tract infections, and third-generation cephalosporins can be used for gram-negative bacteria
.
Carbapenems have good pancreatic tissue permeability, can cover anaerobic bacteria, and are only used in critically ill AP patients
.

References:

[1] Pancreatic Disease Group of Gastroenterology Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Pancreatic Diseases, Editorial Board of Chinese Journal of Digestion.
Guidelines for the diagnosis and treatment of acute pancreatitis in China (2019, Shenyang)[J].
Chinese Journal of Pancreatic Diseases,2019,19(5):321-331.

[2] Emergency Branch of Chinese Medical Association, Beijing-Tianjin-Hebei Emergency Emergency Alliance, Emergency Branch of Beijing Medical Association, Emergency Physician Specialty Branch of Beijing Medical Doctor Association, Emergency Branch of China Medical and Health Culture Association.
Expert consensus on emergency diagnosis and treatment of acute pancreatitis[J].
Chinese Journal of Emergency Medicine,2021,30(2):161-172.

Pancreatology Professional Committee of Chinese Medical Doctor Association.
Consensus Opinions on Multidisciplinary (MDT) Diagnosis and Treatment of Acute Pancreatitis in China (Draft)[J].
Chinese Journal of Pancreatology,2015,15(4):217-224.

SUN Bei,LI Guanqun.
Clinical Research Progress and Prospect of Acute Pancreatitis[J].
Chinese Journal of Practical Surgery,2020,40(2):171-175,179.

Huo Xiaoxia,Li Hui,Zhang Xiaolan.
Research Progress in the Treatment of Acute Pancreatitis[J].
Clinical Collection,2019,34(11):1030-1033.

Hu Xinyue,Zhang Lipeng.
Research Progress on Antimicrobial Drug Treatment of Acute Pancreatitis[J].
Chinese Emergency Medicine for Critical Illness,2018,30(7):708-711.

[7] Guo Jun, Wang Yu, Rao Youyi, et al.
Comparison of drug recommendations for diagnosis and treatment of acute pancreatitis at home and abroad[J].
Medical Review,2019,38(9):1218-1225.

[8] Chinese Medical Association, Journal of Chinese Medical Association, Gastroenterology Branch of Chinese Medical Association, General Practice Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of General Practitioners, Expert Group for Writing Guidelines for Primary Diagnosis and Treatment of Digestive System Diseases.
Guidelines for primary diagnosis and treatment of acute pancreatitis (2019)[J].
Chinese Journal of General Practitioners,2019,18(9):819-825.

[8] Expert Consensus on Emergency Diagnosis and Treatment of Hypertriglyceridemia Acute Pancreatitis.
Expert consensus on the diagnosis and treatment of hypertriglyceridemic acute pancreatitis[J].
Chinese Journal of General Medicine,2021,24(30):3781-3793.

Li Lei,He Wenhua,Lu Nonghua.
Advances in lipid-lowering treatment of hypertriglyceridemia pancreatitis[J].
Chinese Medical Journal,2021,101(21):1619-1621

Zhao Huijia,Wu Dong,Wu Wenming.
Research progress of hyperlipidemic pancreatitis[J].
Union Medical Journal,2022,13(4):637-643.

[11] ZHANG Chunlin,ZHANG Chaogui,TAN Zhonghua.
Application of butorphanol tartrate in patients with invasive mechanical ventilation hyperlipidemia severe acute pancreatitis[J].
Guangxi Medicine,2017,39(4):490-493.

Zheng Wentao,Sun Zhendi,Wang Aiqin.
Analgesic effect of butorphanol on patients with severe acute pancreatitis in ICU[J].
Chinese Journal of Integrative Medicine First Aid,2016,23(6):593-596.

Where to see more clinical knowledge of digestive liver disease? Come to the "Doctor's Station" and take a look 👇