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Question 15 · LEK · Acute pancreatitis

A 57-year-old man was admitted to the hospital with symptoms of acute pancreatitis. He has never been diagnosed with cholecystolithiasis, but he did abuse alcohol the night before. On admission Hct 46%, WBC 16,300/mm³, glucose 189 mg/dL, LDH 279 U/L, AST 193 U/L, serum Ca²⁺ 1.95 mmo/L, urea 1.50 mmol/L, PaO₂ 67 mmHg. On the third day at the hospital: Hct 40%, WBC 13,500/mm³, glucose 163 mg/dL, LDH 183 U/L, AST 170 U/L, serum Ca²⁺ 1.85 mmol/L, urea 1.73 mmol/L, PaO₂ 57 mmHg. According to the Ranson criteria in this patient:

  1. A. severe pancreatitis is unlikely on admission and on the third day of hospitalization.
  2. B. severe pancreatitis is unlikely on admission but it is probable on the third day of hospitalization.
  3. C. severe pancreatitis is probable on admission and on the third day of hospitalization.
  4. D. severe pancreatitis is probable on admission but it is unlikely on the third day of hospitalization.
  5. E. provided data are not sufficient to assess the risk of severe pancreatitis.
Hint

Count Ranson points separately for the admission and the 48-hour criteria; severity depends on their cumulative total.

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