Acute Pancreatitis

Aggressive volume resuscitation - Severe pancreatitis causes huge third-space losses and hypovolemic shock; resuscitate with fluids and support hemodynamics.

Respiratory compromise - ARDS is common; expect impaired oxygenation and ventilate protectively.

Electrolyte and glucose derangement - Hypocalcemia and hyperglycemia occur; monitor and correct.

Renal protection - Acute kidney injury is common; maintain perfusion and urine output and avoid nephrotoxins.

Aspiration and ileus - Ileus, nausea, and a full stomach raise aspiration risk; consider a rapid-sequence induction and precautions.

Acute pancreatitis is autodigestion of the pancreas by its own activated enzymes, triggered most often by gallstones or alcohol.

Mild disease is self-limited, but severe pancreatitis produces a massive systemic inflammatory response: third-space fluid loss and hypovolemic shock, ARDS, acute kidney injury, hypocalcemia, hyperglycemia, and multi-organ failure. The anesthetist may meet these patients for drainage or debridement, or for unrelated surgery — the picture is the critically ill, volume-depleted, inflamed patient with respiratory and renal compromise.