Acute pancreatitis


⭕Acute pancreatitis typically presents with severe sudden-onset mid-epigastric or left upper quadrant abdominal pain, which often radiates to the back. Nausea and vomiting is seen in 80% of patients.
⭕The diagnosis is confirmed in most patients by elevated serum lipase or amylase (>3 times upper limit of normal). Contrast-enhanced computed tomography (CECT) is only required where there is diagnostic doubt or a failure to improve within 72 to 96 hours from onset of symptoms.

⭕The most common causes are gallstones and excessive alcohol consumption.
Initial treatment focuses on resuscitation with intravenous fluids, analgesia, and nutritional support, with early oral feeding favoured if tolerated.

⭕In severe cases, treatment may include support for organ failure; drainage of pancreatic necrosis; and antibiotic therapy ± surgical necrosectomy for infected necrosis.
Approximately 80% of cases are mild but in severe cases the mortality rate is as high as 30%. The pattern of deaths is biphasic, with early mortality (<2 weeks) related to systemic inflammatory response syndrome (SIRS)/multi-organ failure and later deaths (>2 weeks) due to local complications including infected necrosis and pseudocysts.

#BMJ

⭕ Do not use oxygen routinely in non-hypoxaemic patients with acute heart failure because it causes vasoconstriction and a reduction in cardiac output.

#BMJ

✅Give oxygen if the patient has oxygen saturations <90% or PaO2 <8 kPa (<60 mmHg).

✅Monitor controlled oxygen therapy. An upper SpO2 limit of 96% is reasonable when administering supplemental oxygen to most patients with acute illness who are not at risk of hypercapnia.

✅Evidence suggests that liberal use of supplemental oxygen (target SpO2 >96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy.

✅A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure.

✅#BMJ

ESC..

رحمة ربي تغشاه وأسكنه فسيح جناته، الدكتور / أنيس،
عظيم من عظماء الصيدلة، لطالما كان حديثه دائما مترعا بالأمل وتذليل الصعاب..

⭕Management of hyponatremia🔆

✅The initial goal of therapy for most patients with hyponatremia, based on the most recent European and American consensus guidelines, is to raise the serum sodium concentration by 5 mEq/L.8
✅ Mild, asymptomatic hyponatremia (>125 mEq/L) can usually be safely managed with a sodium-containing oral rehydration solution or an increase in oral sodium intake, provided that the oral route is viable (ie, vomiting and diarrhea are
controlled, evidence of functional gastrointestinal [GI] tract).
✅ IV sodium therapy is preferred in severe cases of hyponatremia or
in patients with severe symptoms. In most cases, sodium chloride 0.9% is used, although the recent guidelines recommend using NaCl 3.0% in symptomatic patients.
✅ If a hypertonic saline
solution (eg, ≥NaCl 3.0%) is used, it must be infused via a central
venous catheter because of its high osmolarity.
✅The initial goal for treating acute hyponatremia is to prevent further decline in serum sodium concentration, reverse or
prevent neurologic symptoms, and avoid excessive correction
of serum sodium in patients at risk for osmotic demyelination
syndrome.
✅ In patients with sodium concentration >120 mEq/L
with no or mild symptoms, acute correction of serum sodium
concentration may not be warranted. ✅ In symptomatic patients
with serum sodium concentration <120 mEq, increase serum
sodium by up to 4 to 6 mEq/L within 24 hours of baseline or
until symptoms improve.
✅The risk of osmotic demyelination
syndrome has been reported after correction by 9 mEq/L per
day.
✅ Neurologic deficits would improve with this target rate
of change in serum sodium concentration.
✅The average rate of
increase in serum sodium should not exceed 1 to 2 mEq/L/hr
and a total of 9 mEq/L in any given 24-hour period.
✅Excessive correction of serum sodium concentration during the course of treatment, and not just the first or second day, may result in
osmotic demyelination syndrome. There is no evidence that the
first day’s correction should be greater than on other days. There
is no evidence that correction of serum sodium by >10 mEq/L
in 24 h or 18 mEq/L in 48 hours improves outcomes in patients
with acute or chronic hyponatremia..

In ACS management

Loading dose of clopidogrel:

Pre-PCI after fibrinolytic therapy: ✅300-mg LD if within 24 hr of event; ✅clopidogrel 600-mg LD if > 24 hr after event.
Because :
A 600-mg LD results in greater, more rapid, and more reliable platelet inhibition than a 300-mg LD.

Loading dose of Aspirin :

✅Initiate 162–325 mg of ASA before PCI; after PCI, give 81 mg ASA • 2013 ACCF/AHA guideline for STEMI • 2021 AHA/ACC/SCAI Guideline for Coronary Artery Revascularization I I

✅Initiate 81–325 mg of non–enteric-coated ASA before PCI in patients already taking ASA; in patients not taking ASA, give 325 before PCI; after PCI, continue 81 mg ASA • 2014 NSTE-ACS guideline • 2021 AHA/ACC/SCAI Guideline for Cornonary Revascularization


⭕Ref. : ACCP 2023

أنت لا تعلم معنى أن يرتكب في كل يوم مجزرة جديدة في حق قومٍ نازحين عزل؟؟
ذلك يعني أنه لا سبيل للنجاة مهما حالف الحظ أحدهم ونجا إلا أنه يعلم بأنه الشهيد القادم، إلا أنهم ما زالوا متمسكون بالحياة ينزحون إلى أماكن يعلمون أنها ستطالها يد العدو ما داموا فيها..
ذلك يعني أنه كتب على هذه الأرض أن تعيش أشد وأقسى ما يرتكب من جرائم،
ذلك يعني أنهم عاشوا خذلانا دون وجود أي ذرة للأمل في نصرتهم إلا من الله،
ذلك يعني مزيدا من الشهداء مزيدا من الأطفال التي ترقى أرواحهم الطريّة إلى بارئها، مزيدا من الجراح التي لا تشفى، مزيدا من النساء اللاتي يهاجرن إلى الله وقد كنّ يأملن أن يربين مزيدا من الشباب المجاهدين الشرفاء، مزيدا من الأشلاء التي لن تجد من يجمعها..
ذلك يعني مزيدا من القلق مع الشعور بالعجز قهرا حين لا نملك أن نصنع شيء من أجلهم نحن معشر الضعفاء الخانعون عند فهلوات ذواتنا و روتين ممل حد القرف،
ذلك يعني مزيدا من الصمت، صمت يطبق أفواه ذوي القدرات، وأصحاب الجيوش المدججة التي حرمتها فرضية الحدود التي كانت من منجزات ذاك المحتل..

يا الله وحدك تملك تلك القدرة العجيبة في الانتقام، انتقم لنا منهم ياالله..! 💥

..

⭕ Community-Acquired Infections of Mild-to-Moderate Severity in Adults Antibiotics:

✅used for empiric treatment of community-acquired intra-abdominal infections should be active against enteric gramnegative aerobic and facultative bacilli and enteric gram-positive streptococci.

✅ For patients with mild-to-moderate, community-acquired infections, regimens with substantial anti-pseudomonal activity are not required.

✅ Empiric coverage of Enterococcus is not necessary in patients with mild-to-moderate community-acquired intra-abdominal infection.

✅ The use of agents listed as appropriate for high-severity, community-acquired infection and healthcare-associated infection is not recommended for patients with mild-to-moderate, community-acquired infection, because such regimens may carry a greater risk of toxicity and facilitate acquisition of more resistant organisms.


🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🔴

⭕High-Severity Community-Acquired Infections in Adults.

✅ The empiric use of antimicrobial regimens with broad-spectrum activity against gram-negative organisms including Pseudomonas spp., such as meropenem, imipenem/cilastatin, piperacillin–tazobactam, ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime or cefepime in combination with metronidazole, is recommended for patients with high-severity, community-acquired intra-abdominal infection.

☑️Aztreonam plus metronidazole is an alternative, but addition of an agent effective against gram-positive is recommended.

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡

⭕Healthcare-Associated Infections in Adults.

✅ Empiric antibiotic therapy for healthcare-associated intra-abdominal infections should be driven by local microbiologic results.

✅ To achieve empiric coverage of likely pathogens, multidrug regimens that include agents with expanded spectra of activity against gram-negative aerobic and facultative bacilli may be needed. These agents include meropenem, imipenem/cilastatin, piperacillin/
tazobactam, or metronidazole combined with either cefepime or ceftazidime.

✅ For multidrug-resistant aerobic gram-negative pathogens, aminoglycosides, colistin, polymyxin B, meropenem/vaborbactam, imipenem/relebactam, eravacycline, cefiderocol, ceftazidime/avibactam, or ceftolozane/tazobactam may be required.

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡

⭕#Note

✅Ampicillin/sulbactam is not recommended for use because of high rates of resistance to this agent among community-acquired E. coli.

✅Quinolone-resistant E. coli have become common in some communities, and quinolones should not be used unless hospital surveys indicate 90% susceptibility of E. coli to quinolones.

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡

⭕Duration of Therapy:

✅ Antimicrobial therapy of established infection should be limited to 4 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.

✅For acute stomach and proximal jejunum perforations, in the absence of acid-reducing therapy or malignancy and when source control is achieved within 24 hours, prophylactic anti-infective therapy directed at aerobic gram-positive cocci for 24 hours is adequate.

✅ Bowel injuries attributable to penetrating, blunt, or iatrogenic trauma that are repaired within 12 hours and any other intraoperative contamination of the operative field by enteric contents should be treated with antibiotics for ≤24 hours .

✅Acute appendicitis without evidence of perforation, abscess, or local peritonitis requires only prophylactic administration of narrow spectrum regimens active against aerobic and facultative and obligate anaerobes; treatment should be discontinued within 24 hours .

✅ The administration of prophylactic antibiotics to patients with severe necrotizing pancreatitis prior to the diagnosis of infection is not recommended.

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡

🔰Therapeutic Notes🔰
🟡@WikipharmaDr 🟡