Home Treatment of Acute Pancreatitis
Home Treatment of Acute Pancreatitis
Acute pancreatitis (AP) is considered a disease requiring in-hospital treatment. We studied
 the feasibility of home management in AP.The aim of study was to compare 30 day readmission
 rates in patients with mild non-alcoholic acute pancreatitis (NAAP) randomized to home
 monitoring versus hospitalization.
Between 11/11-5/12, 84 patients with mild NAAP were randomized to home or hospital groups
 after a short (≤24 hours) hospital stay. AP was defined as ≥2 or more of the following:
 characteristic abdominal pain, amylase and/or lipase ≥3X the upper limit of normal, and/or
 imaging findings. Patients with an Imrie's score ≤5 and a harmless acute pancreatitis score
 (HAPS) ≤2 were included. Patients in both groups received intravenous lactated Ringer for 3
 days and pain was treated with intramuscular diclofenac. A nurse visited all patients in the
 home group on the 2nd, 3rd and 5th day. All patients recalled for follow-up on the 7th, 14th,
 and 30th days.
Inclusion Criteria:

 -  Diagnosis of AP based on 2 out of 3 findings: characteristic abdominal pain, amylase
 and/or lipase levels ≥3 times the upper limit of normal, and/or abdominal imaging
 demonstrating changes of acute pancreatitis

 -  Presentation within 48 hours of symptom onset

 -  Imrie's scores of ≤5 and HAP score ≤2 within 24 hours of presentation to the hospital

 -  Lack of hemoconcentration (hematocrit ≥44%) on presentation since hemoconcentration
 has been shown to be a risk factor for pancreatic necrosis.

 Exclusion Criteria:

 -  The presence of organ failure by the Atlanta criteria on the first day of presentation

 -  The presence of clinical signs and/or symptoms of sepsis

 -  Alcoholic acute pancreatitis

 -  A history of abdominal imaging demonstrating a dilated pancreatic duct and/or
 pancreatic calcifications

 -  Coagulopathy (international normalized ratio >1, and/or platelet count <50,000/mm3

 -  Comorbidities requiring hospitalization regardless of the presence of AP e.g. acute
 myocardial infarction, malignancy, cirrhosis, chronic kidney disease, and chronic
 pulmonary disease)