Background: Prior studies have found Black and Hispanic patients are more likely to experience disparities in pain management. Fewer studies have evaluated pain control based on age, sex, body mass index (BMI), or presence of a substance use disorder (SUD). While factors influencing management of acute pain are complex, striving for adequate pain control remains [...]

Background: Acute pancreatitis (AP) is one of the most common causes of hospitalization in the United States. Intravenous hydration with normal saline (NS) is the most commonly used fluid for resuscitation. Recent studies have shown better outcomes with the use of more pH balanced fluid-like ringer’s lactate and Plasmalyte (PL). We conducted a retrospective cohort [...]

Background: The presence of concomitant diabetic ketoacidosis (DKA) with acute pancreatitis (AP) is not uncommon and is associated with unfavorable outcomes (1,2). However, the diagnosis of AP in DKA patients is often missed because of the overlapping clinical features. Data comparing clinical characteristics and outcomes of patients with co-existing DKA and AP with DKA alone [...]

Background: Severe hypertriglyceridemia (triglyceride >1000 mg/dl) occurs at a rate of 0.4% and is associated with a range of medical complications including severe pancreatitis and its complications like acute kidney injury . Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis especially in levels above 1000 mg/dl. It has been suggested that insulin [...]

Background: Acute pancreatitis is among the most common and costly reasons for hospitalization in the United States. While bowel rest, pain control, and intravenous fluids are the cornerstone of treatment, recent evidence suggests that early rather than delayed feeding may be beneficial. Guidelines, however, continue to recommend waiting for clinical improvement before feeding. We thus [...]

Background: Choosing Wisely recommends against testing for amylase in the diagnosis and management of acute pancreatitis; however, national CMS data shows over $19 million in charges for amylase laboratory testing per year. Our hospital spent over $341,000 on roughly 38,000 amylase orders in the past year. Purpose: We developed a quality improvement project to reduce [...]

Background: Decades-old clinical data and practice guidelines support the use of lipase over amylase in the workup and management of acute pancreatitis. Yet, laboratory testing for amylase continues to cost the Center for Medicare and Medicaid Services more than $19 million in largely avoidable charges each year. Previously hypothesized drivers of overutilization of amylase testing [...]

Case Presentation: A 39 year-old female with a history of hypertriglyceridemia (HTG), IDDM2, and obesity presented to an outside hospital with severe epigastric abdominal pain and was diagnosed with recurrent hypertriglyceridemia-induced pancreatitis (HTGP). Intravenous insulin was started and she was transferred to our hospital for management. On arrival, she was tachycardic and tachypneic with a [...]

Case Presentation: A 58-year-old man with a medical history of recurrent acute on chronic pancreatitis due to alcohol use disorder presented with a 3-day history of right-sided pleuritic chest pain and dyspnea. Chest X-ray revealed a new large right-sided pleural effusion.   Analysis of the aspirated serosanguinous exudative pleural fluid yielded a total amylase of 24,600 [...]

Case Presentation: A 41-year-old male with a past medical history of chronic alcoholic pancreatitis and right-sided pancreatic pseudocyst presented with shortness of breath and right-sided chest pain that began three days prior. Chest X-ray showed near-complete opacification of the right hemithorax. A diagnostic thoracentesis revealed an exudative pleural effusion with a pleural amylase level of [...]