# Acute Pancreatitis (Emergency Referral) - Category: emergency - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## 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. ## Treatment metadata - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text ACUTE PANCREATITIS (EMERGENCY REFERRAL) 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 against 3 sources listed above (2026-08) 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 Source StatPearls "Acute Pancreatitis" - disease-level clinical article Status 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 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 Peds Uncommon in children; trauma, viral infection and drugs are the usual causes. Refer as an emergency. Source No dose - referral pathway, no medicine given in primary care Caution 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 [add-on - not a substitute] Adult 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 Peds 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.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) 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. Caution 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. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)