This handout is for acute pancreatitis. Your care team identified this based on: epigastric pain radiating to back — revised atlanta 2012 diagnostic criterion 1 of 3.
Other reasons your team may use this plan: lipase >3× upper limit of normal — revised atlanta 2012 + acg 2024 tenner diagnostic criterion; ct/mri showing pancreatic inflammation/necrosis — revised atlanta 2012 diagnostic criterion 3 of 3.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| lactated_ringers | WATERFALL — 1.5 mL/kg/h continuous (moderate); 10 mL/kg bolus only if hypovolemic (avoid aggressive 5-10 mL/kg/h based on WATERFALL 2022 NEJM) | IV | continuous | WATERFALL de-Madaria NEJM 2022 — moderate fluids reduce fluid overload morbidity vs aggressive; LR preferred over NS (ACG 2013 Tenner) |
| hydromorphone | 0.5-1 mg IV q3-4h PRN | IV | q3-4h PRN | Multimodal — ACG 2024 Tenner prefers hydromorphone over morphine; morphine acceptable (no clinical evidence of sphincter of Oddi spasm) |
| acetaminophen | 1 g IV/PO q6h max 4 g/day | IV/PO | q6h | Multimodal pain control adjunct — ACG 2024 Tenner |
| ondansetron | 4 mg IV/PO q6h PRN | IV/PO | q6h PRN | Symptom control — ACG 2024 Tenner |
Plan: Acute pancreatitis severity-driven regimen — ACG 2024 + WATERFALL fluid + IAP/APA 2025
Call 911 or go to the nearest emergency room right away if you have:
GI follow-up 2-4 weeks — ACG 2024 Tenner; cholecystectomy timing for biliary — PONCHO da Costa Lancet 2015; alcohol/TG control — ACG 2024 Tenner; EPI screen post-necrotizing; recurrence workup if ≥2 episodes — ACG 2024 Tenner
Guideline: ACG 2024 Acute Pancreatitis Guideline + IAP/APA Revised Guidelines 2025 + Revised Atlanta 2012 + WATERFALL (NEJM 2022) + PONCHO (Lancet 2015) + ESCAPE (Lancet 2018)