Mar 16, 2014 acute pancreatitis, with an incidence between 0. Management of drug induced acute pancreatitis requires withdrawal of the offending agent and supportive care, and failure to identify a drug that is the offending agent can result in critical delays. A case of probable ibuprofen induced acute pancreatitis paul magill1, paul french ridgway1, kevin christopher conlon2, paul neary1 1department of general and vascular surgery. Full text get a printable copy pdf file of the complete article 6k, or click on a page image below to browse page by page. The pancreas is a large gland behind the stomach and close to the first part of the. Endoscopic retrograde cholangiopancreatography ercp is a procedure that evaluates the gallbladder or pancreas. Because initiation of repaglinide presumably corresponded to an episode of acute pancreatitis in our patient and discontinuation resulted in resolution of symptoms, repaglinide is strongly suggested to be the cause. Prevention of druginduced pancreatitis requires an uptodate knowledge of drugs with the. In conclusion, drugs rarely cause acute pancreatitis, and drug induced acute pancreatitis usually runs a benign course. Several causative agent classification systems have been proposed, but they require regular updates.
The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. In our case, all other possible causes of pancreatitis were ruled out. Among its many causes ethanol is preeminent, but many other drugs have also been incriminated. Long school of pharmacy and health sciences, university of the pacific, stockton, ca 3department of anesthesiology, louisiana state university health sciences center. Nov 30, 2012 acute pancreatitis has a high morbidity and significant mortality. We report a case of possible rosuvastatin induced pancreatitis. Our patient had been smoking cannabis for 3 months before the onset of acute pancreatitis. The literature on statininduced pancreatitis consists primarily of anecdotal case reports. However, yadav et al 2009 in andris, 20 determined that smoking was a significant risk factor for pancreatitis independent of alcohol use. Purina veterinary diets, vevey, switzerland for case 10. Furthermore, a diagnosis of druginduced pancreatitis is usually made if. Dapagliflozin induced pancreatitis international journal of. Recurrent acute pancreatitis probably induced by rosuvastatin.
The source of abdominal pain can be very difficult to identify in the older adult. The effects of propofol on serum lipid concentrations remain controversial. Markedly elevated labs which returned to near normal within 3 days. The symptoms and signs associated with acute pancreatitis are. An experimental study demonstrated that a decrease in extracellular fluid volume impairs pancreatic blood flow, which leads to ischemia 22. Potential publication bias may also impact our knowledge of diap. Druginduced pancreatitis is mostly acute or recurrent acute pancreatitis, specifically in highrisk populations e. Given the lack evidence in the literature for doxepin causing pancreatitis, and taking into considera. The majority of drug induced pancreatitis cases are mild to moderate in severity. The diagnosis is based on the combination of clinical and laboratory aspects with. Although serum lipids were not reported, the evidence suggested that an estrogeninduced hypercoagulable state was respon sible for the thromboses, infarcts, and pancreatitis. Primary isolated case of drug induced pancreatitis.
A diagnosis of viral infection, with a concurrent ap diagnosis, a temporal resolution of both entities and the attempt to exclude the most common etiologies of ap defined viral induced ap. In a casecontrol study, blomgren and sudstrom 2002 found an increased risk of firsttime acute pancreatitis among diabetic. Many drugs have been suspected of causing pancreatitis, but the true incidence is not known as the evidence is derived mainly from random case reports. Less convincing, but suggestive evidence exists for. The two major forms of inflammatory pancreatic diseases acute and chronic pancreatitis are different entities which require different nutritional approaches. Since that time, there have been reports of pancreatitis occurring in association with at least 25 different drugs. The use of ace inhibitors has been associated with an increased risk of acute pancreatitis adjusted odds ratio 1. One speculative mechanism of metronidazole induced pancreatitis is that under aerobic conditions, it may undergo redox cycling and yield hydrogen peroxide, superoxide, and other free radicals, which can be toxic to pancreatic beta cells and induce pancreatitis. One hour following the last injection of larginine, the rats were treated orally as follows. Acute pancreatitis is a common inflammatory disorder of the pancreas and its incidence is increasing among hospitalized patients worldwide. Druginduced pancreatitis is rare with an estimated incidence of.
In contrast, severe pancreatitis is characterized by pancreatic dysfunction, local and systemic complications, and a complicated recovery. The elderly may be especially susceptible to drug induced pancreatitis due to polypharmacotherapy and mixed drug interactions nitsche et al, 2010. Department of medicine, pancreas center, university of verona, verona, italy. Druginduced acute pancreatitis confirmed by positive rechallenge. In addition, pancreatitis may be further classified into acute interstitial and acute hemorrhagic disease figure 2. Full text dk94022 pathophysiology of alcohol and drug induced pancreatitis nih guide, volume 23, number 22, june 10, 1994 rfa. We searched the national library of medicinepubmed for reported cases of dip from 1966 to april 30, 2004. Case reports with the strongest evidence are those that clearly diagnose pancreatitis and exclude common aetiologies, provide the dose and time. There have been many published reports of possible cases of drug induced pancreatitis. The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis. Because hypertriglyceridemia is a known cause of pancreatitis, the possibility that pancreatitis could occur due to hypertriglyceridemia induced by propofol must be addressed. Acute pancreatitis ap is a heterogeneous disease ranging from a clinically mild form to a more severe forms associated with high morbidity and mortality 78. In 1959, johnston and cornish reported 4 patients with acute pancreatitis associated with thiazide therapy. Evaluate the management of htg, including clinical guidelines, pharmacological therapy, and supportive primary literature 5.
A 67yearold female presented with progressively worsening abdominal pain and vomiting for 7 days. The true incidence is not entirely clear since only few systematic population based studies exist. Jul 25, 2019 these cases of acute pancreatitis tend to be milder than cases of acute biliary or alcohol induced pancreatitis. Pegaspargaseinduced pancreatitis university of miamis. Acute pancreatitis reversible inflammation of the pancreas ranges between mild, moderate, and severe attacks can be once or recurring prognosis o differs depending on severity o organ failure within 24 hours of admit significantly increases risk of death 1 morbidity o 210, 000 hospitalizedyear for acute pancreatitis 1.
Druginduced pancreatitis is less prevalent compared to other causes of acute pancreatitis, the incidence ranges between 0. There was no history of alcohol use and no family history of pancreatitis. Drug induced pancreatitis is mostly acute or recurrent acute pancreatitis, specifically in highrisk populations e. Drug induced pancreatitis is less prevalent compared to other causes of acute pancreatitis, the incidence ranges between 0. Espen guidelines on nutrition in acute pancreatitis. Become familiar with the various classification schemes for htg 4. The diagnosis of drug induced acute pancreatitis often is difficult to establish. Druginduced pancreatitis was not considered as the child had not received any drugs known to cause acute pancreatitis 16. Discuss the association between htg and acute pancreatitis 6. Graft pancreatitis studies and nonenglish publications were excluded. A case of probable ibuprofeninduced acute pancreatitis. The symptoms and signs associated with acute pancreatitis. To our knowledge, there is only one reported case of estrogen induced pancreatitis in a maletofemale transgender person who was taking estrogen therapy 4.
The majority of druginduced pancreatitis cases are mild to moderate in severity, but severe and even fatal cases can occur. Three dogs with ad were maintained on hypoallergenic diets. As compared to adults under 50, abdominal pain in the older adult is much more likely to be related to serious medical conditions. What is the optimal method and timing of alcohol cessation counseling in patients with acute alcohol. There have been over 40 reported cases all women in which estrogen therapy has been the causativeagent of drug induced pancreatitis 1. Although we know that activation of trypsin can lead to pancreatic. A pubmed search of olanzapine induced pancreatitis revealed 11 case reports from 2000 to the current date 6 but no case reports in australasia. This is a technique that uses xray to view the patients bile and pancreatic.
Most cases of drug induced pancreatitis reported followed a mild or moderate course. Acute pancreatitis is an inflammatory condition of the pancreas characterized by abdominal pain and elevated levels of pancreatic enzymes in the blood. Finally, patients with inflammatory bowel disease have an increased risk of drug induced pancreatitis, but these patients are also believed to suffer from an increased risk for acute pancreatitis due to their underlying disease, 12. The goal of this paper is to bring to light the often occult but real problem of drug induced pancreatitis dip. Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock. Elaborate the potential causes, complications, and management of acute pancreatitis 3. The purpose of this study is to report the incidence of pancreatitis in patients treated with pegaspargase in our hospital during a 2year period.
Highly purified ulinastatin has been clinically used for the treatment of acute pancreatitis, chronic pancreatitis, stevensjohnson syndrome, burns, septic shock, and toxic epidermal necrolysis ten. Finally, patients with inflammatory bowel disease have an increased risk of druginduced pancreatitis, but these patients are also believed to suffer from an increased risk for acute pancreatitis due to their underlying disease, 12. Inh induced pancreatitis virginia department of health. Drugs and drug classes associated with acute pancreatitis are summarized in table 2. Viral infections were diagnosed by serology andor histology. George claims to be nauseas, especially when eating, he was vomiting, he had tachycardia, and when the doctor palpated his back he had. Generating an epub file may take a long time, please be patient.
This article begins with a definition of the mechanisms, pathogenesis and clinical features of acute pancreatitis. Knowing which agents are the likely culprits improves management. Suggested mechanisms of action for furosemide induced ap include a direct toxic effect to the pancreas, diuretic induced stimulation of pancreatic secretion, and ischemia 8, 17, 19. We evaluated the extent of this adverse effect in patients on thiazide on our follow.
In 2009, it was the most frequent diagnosis in patients discharged from gi services in the us and the fifth leading cause of inhospital mortality. Iapapa evidencebased guidelines for the management of acute. The following figure shows that pde4, which mn166 is an inhibitor of, is increased by lps stimulation and that treatment with mn166. An acute inflammatory process that leads to necrosis of the pancreatic parenchyma. In this study, however, heavy smokers tended to be heavy drinkers, thus compounding the risk factors for pancreatitis. In conclusion, we have described a case of cannabis induced pancreatitis. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. Two dogs with pancreatitis cases 2 and 6 were fed a high. Elizabeth carsten, dvm, dacvimidexx reference laboratories, internal medicine background pancreatitis is a potentially fatal disease which occurs commonly in dogs. The knowledge of drug induced acute pancreatitis diap is limited by the availability and the quality of the evidence. Propofol and postoperative pancreatitis anesthesiology. Mortality ranges from 3 percent in patients with interstitial edematous pancreatitis to 17 percent in patients who develop pancreatic. Most cases of druginduced pancreatitis reported followed a mild or moderate course. Many of them are widely used to treat highly prevalent diseases.
Ulinastatin, as an urinary trypsin inhibitor uti, is a glycoprotein that is isolated from healthy human urine or synthetically produced and has molecular weight of 25 25kda. Drugs are thought to be a rare cause for acute pancreatitis. Druginduced pancreatitis definition of druginduced. Several conditions are associated with acute pancreatitis. Drugs are a relatively rare cause of acute pancreatitis, with an estimated incidence of 0. Causes include alcohol consumption, presence of gallstones, trauma, and drugs. We limited misdiagnosis of acute pancreatitis by checking the computerised medical files and by requesting additional information from the gp.
Acute pancreatitis is an acute inflammatory process of the pancreas. The disease is challenging to diagnose as symptoms vomiting, anorexia and abdominal pain tend to be common and nonspecific. There are no reports on doxepinrelated pancreatitis from 1966 to the current date. Get concise advice on drug therapy, plus unlimited access to ce. There are two main types, acute pancreatitis and chronic pancreatitis. A possible pathogenesis of pancreatitis secondary to propofol can only be speculated.
Since 1959, when the first report on drug induced pancreatitis was published by johnston and cornish 58, at least 50 different drugs have been implicated as possible but rare causes of pancreatitis. Underreporting of druginduced pancreatitis dip is often a result of a low index of suspicion, mild cases with unrecognized subclinical enzyme elevations, missing the time frame for drugrelated exposures, and erroneous classification. This is the first such case in the literature and it reinforces the fact that drug induced or aggravated pancreatitis is a. Quinidine induced hypoprothrombinemic hemorrhage in patients on chronic warfarin therapy. Preclinical evolutionary study of alphapinene in l. Interaction of quinidine with anticonvulsant drugs. Pancreatitis and cancer chemotherapy annals of internal. Viral causes include mumps virus, coxsackievirus, cytomegalovirus cmv, hepatitis virus, epsteinbarr virus ebv, echovirus, varicellazoster virus vzv, measles virus, and rubella virus. Markedly elevated labs which returned to near normal within 3 days of stopping inh and completely normal within two months.
In addition, some disease states and patient characteristics predispose particular populations to the development of this condition. We report a case of possible rosuvastatininduced pancreatitis. Although thiazide drugs are increasingly being used in clinical practice, data on incidence of acute pancreati tis with this class of drug are lacking. Acute pancreatitis is an uncommon complication of cancer chemotherapy, and has been described in association with the use of lasparaginase 1, 2, corticosteroids 3, and cytarabine 4. Acute pancreatitis develops in about 3% to 5% of people who undergo ercp. Although the incidence of acute pancreatitis ap in children is increasing. Acute pancreatitis is a leading gastrointestinal cause of hospitalization in the united states. The literature on statin induced pancreatitis consists primarily of anecdotal case reports. Many frequently prescribed drugs are suspected to cause acute pancreatitis ap. Pancreatitis, cholecystitis, appendicitis, and gastroenteritis. Medications implicated in ap are classified based on the. Pancreatitis is a condition characterized by inflammation of the pancreas. Acute pancreatitis was induced in five groups of rats by two intraperitoneal ip injections of larginine 2.
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