{ "schema_version": 1, "kind": "condition", "id": "acute-pancreatitis", "name": "Acute Pancreatitis (Emergency Referral)", "category": "emergency", "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.", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 77, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": null, "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Uncommon in children; trauma, viral infection and drugs are the usual causes. Refer as an emergency.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-pancreatitis" }, { "id": 76, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g three or four times daily, maximum 4 g in 24 hours", "adult_duration": "While the pain lasts; not a reason to delay admission by a single hour", "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.", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "acute-pancreatitis" } ] }