Dawaa Reference

emergency

Acute Pancreatitis (Emergency Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Acute Pancreatitis - StatPearls, updated 2 August 2025 - https://www.ncbi.nlm.nih.gov/books/NBK482468/ · MSF Essential Drugs 2024 - paracetamol (oral) · MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling used in the weight table is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.

Verified against3 documents
  • Acute Pancreatitis - StatPearls, updated 2 August 2025 - https://www.ncbi.nlm.nih.gov/books/NBK482468/
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling used in the weight table is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Moderate to severe epigastric pain, often deep, burning, or stabbing, radiating to the back, is the classic complaint [abdominal pain · epigastric pain]
  • Onset is usually sudden, though alcohol-related cases can build more gradually and less focally
  • Nausea, vomiting, and loss of appetite commonly go along with the pain [nausea · poor appetite · vomiting]
  • Heavy alcohol use for more than 5 years is a key history point
  • Weight loss or new-onset diabetes raises concern for an underlying pancreatic tumor [weight loss]
  • Family history matters in patients under 30 without an obvious cause, pointing to a genetic predisposition

Signs — what you find (8)

  • Fever and a fast heart rate are common; blood pressure can drop in severe disease from fluid shifts or systemic inflammation [fever · tachycardia]
  • Dry mucous membranes, slow capillary refill, and poor skin turgor point to volume depletion [cold peripheries · dehydration]
  • Pressing on the epigastrium typically elicits tenderness, guarding, or mild rigidity [guarding]
  • Reduced bowel sounds suggest ileus, and abdominal distension is more common in severe or necrotizing disease [abdominal distension]
  • Bruising around the navel or in the flank points toward bleeding into the retroperitoneum [bleeding · bruising]
  • Jaundice can reflect a blocked bile duct or coexisting cholangitis [jaundice]
  • A palpable epigastric mass may signal a pseudocyst or fluid collection around the pancreas
  • Confusion, especially in older patients, can point to severe systemic illness or a metabolic disturbance [confusion]

Tests (12)

  • Diagnosis under the Revised Atlanta Classification needs at least 2 of 3 defined criteria
  • A lab criterion: amylase or lipase at least 3 times above the upper limit of normal
  • An ALT above 150 U/L in the first 48 hours predicts gallstone pancreatitis with over 85% positive predictive value
  • Right upper quadrant ultrasound should be done in every patient to check for gallstones, dilation, or sludge
  • The threshold for heavy alcohol use is 4 to 5 alcoholic drinks per day, sustained for a minimum of 5 years
  • No single lab test confirms alcohol as the cause; history remains the main diagnostic tool
  • Initial labs should include lipase, amylase, liver function tests, calcium, and triglycerides
  • Rising BUN and hematocrit can signal inadequate fluid resuscitation and predict worse outcomes
  • Ultrasound is the preferred first imaging test in every patient to look for a biliary cause
  • Contrast CT is commonly used to look for pancreatic necrosis, pseudocyst, or infection
  • Cross-sectional imaging comes into play only if the picture stays unclear, or if a patient is not improving after 48 to 72 hours
  • Severe disease is defined by organ failure lasting more than 48 hours, necrosis, or systemic complications

If not this — what else fits (7)

  • Peptic ulcer disease can mimic pancreatitis and may perforate into peritonitis
  • Acute cholecystitis overlaps with biliary pancreatitis through right upper quadrant pain and fever
  • Consider mesenteric ischemia if the pain is severe but the exam findings seem mild by comparison
  • An inferior-wall MI can present as epigastric pain and vomiting, needing ECG and troponin to exclude
  • Diabetic ketoacidosis can mimic pancreatitis, causing abdominal pain and a raised amylase
  • Aortic dissection should be suspected with tearing chest or back pain, unequal pulses, or neurologic signs
  • In a patient with low blood pressure and back or flank pain, think about a ruptured abdominal aortic aneurysm

SourceStatPearls "Acute Pancreatitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Non-opioid analgesia, alongside what the hospital gives

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Emergency admission. Sudden, severe epigastric pain radiating through to the back, with nausea and vomiting. Diagnosis needs two of three: that pain, a serum amylase or lipase three or more times the upper limit of normal, or imaging. Gallstones and alcohol account for most of it. Do not manage this in the community and do not wait for a lipase result before referring a patient who looks unwell. - Refer, with advice

Paediatric dose

Uncommon in children; trauma, viral infection and drugs are the usual causes. Refer as an emergency.

Dose source

No dose - referral pathway, no medicine given in primary care

Cautions
  • Fluid resuscitation in the first hours is what changes the outcome, and it happens in hospital.
  • StatPearls is explicit that prophylactic antibiotics are avoided in sterile necrosis - do not start an antibiotic on suspicion before transfer.
  • A normal amylase does not exclude it, particularly late in the illness or in hypertriglyceridaemic pancreatitis.
  • Ask about alcohol and about gallstones: the cause changes what happens after discharge, including whether the gallbladder comes out.

NON-OPIOID ANALGESIA, ALONGSIDE WHAT THE HOSPITAL GIVES - give alongside

2

PARACETAMOL

Non-opioid analgesia, alongside what the hospital gives

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours - While the pain lasts; not a reason to delay admission by a single hour

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(15 mg/kg per dose three or four times daily from 1 month of age, maximum 60 mg/kg per day. Under 1 month, 10 mg/kg per dose three or four times daily, maximum 40 mg/kg per day. In severe acute malnutrition MSF reduces it to 10 mg/kg up to three times in 24 hours. Pancreatitis in a child is uncommon and always an admission.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling used in the weight table is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.

Why

The pancreatitis article puts pain management on the World Health Organization's analgesic ladder and names acetaminophen among the non-opioid adjuncts that may add benefit in selected patients. It is the only analgesic on that card that a general practice can give while the admission is arranged, and it does not carry the nephrotoxic and gastric risks that make an NSAID a poor choice in a hypovolaemic patient.

Cautions
  • AN ADJUNCT ONLY, AND NOT THE MAIN TREATMENT. The article says most patients need step 3 of the analgesic ladder - intravenous opioids, with hydromorphone and fentanyl preferred and meperidine avoided for its neurotoxicity - and it names those agents without stating a dose for any of them, so none is printed here. The opioid is given by the admitting team.
  • Emergency admission comes first. Sudden severe epigastric pain boring through to the back, with amylase or lipase three or more times the upper limit of normal, or the imaging, makes the diagnosis; the article warns against waiting for a lipase result in a patient who looks unwell.
  • Fluid, not analgesia, is the cornerstone of the first hours, and it is given intravenously in hospital. The article's preferred fluid is lactated Ringer solution, and it now favours moderate individualised resuscitation over the aggressive approach: the WATERFALL trial gave a 10 mL/kg bolus only if the patient was hypovolaemic, then 1.5 mL/kg per hour, against 20 mL/kg then 3 mL/kg per hour, and stopped early because fluid overload reached 20.5% in the aggressive arm against 3.3%, with no clinical benefit. The goal is urine output above 0.5 mL/kg per hour.
  • Prophylactic antibiotics are NOT given for sterile necrosis. The article reserves antimicrobials for a confirmed or strongly suspected infection such as cholangitis, infected necrosis, pneumonia or urinary tract infection.
  • Check every other product the patient is taking for paracetamol - cold and flu sachets are the usual route to an accidental overdose - and reduce the maximum in liver disease, which matters here because alcohol is one of the two commonest causes of the pancreatitis itself.
  • Gallstones and alcohol account for most cases, so the cause has to be pursued after recovery; untreated, it recurs.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.