The Curious Clinicians 92 - When the Cause is the Remedy
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Jun 26, 2024 Exploring the absence of steroid use in acute pancreatitis despite inflammation, with a focus on predictive tools and inflammatory markers. Evolution of IV fluid resuscitation, historical context of cortisone use, recent studies on cortisone benefits. Controversies surrounding steroids and insights on rectal endomethacin for pancreatitis treatment.
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Pancreatitis Is Highly Inflammatory
- Acute pancreatitis is a highly inflammatory condition evidenced by elevated cytokines like IL-6 and inflammatory markers such as ESR and CRP.
- These biomarkers predict disease severity and organ failure, underlining the inflammation's clinical importance.
Moderate Fluids in Pancreatitis
- Fluid resuscitation in acute pancreatitis has shifted towards a moderate approach, similar to current sepsis management.
- Aggressive early fluids worsen outcomes by causing volume overload, so less intensive resuscitation is preferred.
1952 Early Steroid Use Case
- In 1952, a woman with severe hemorrhagic pancreatitis improved after cortisone doses during shock despite overall critical illness.
- This was one of the earliest intentional uses of steroids in pancreatitis, suggesting potential benefit though outcomes were mixed.