Severe acute pancreatitis (SAP) is a life-threatening form of pancreatitis, with up to 30% mortality.

SAP may lead to hypovolemic shock (secondary to vasodilation and capillary leak), hypoxemia (from acute respiratory distress syndrome), and multi-organ failure.

Suspect SAP with signs and symptoms of pancreatitis plus any of the following:

• Hypotension
• Hypoxemia
• Elevated hematocrit (secondary to hemoconcentration)
• Metabolic acidosis
• Decreased ionized calcium

Treatment of SAP should focus on:

• Hemodynamic support including intravascular volume repletion
• Respiratory support to correct hypoxemia
• Screening for abdominal compartment syndrome (risk increased with SAP)
• Prophylactic antibiotics are not recommended

References

Greer, S. E., & Burchard, K. W. (2009). Acute pancreatitis and critical illness: a pancreatic tale of hypoperfusion and inflammation. Chest, 136(5), 1413–1419.

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