Symptom Management

Fever, Chills and Night Sweats
Fever, chills and night sweats can signal a pancreatitis flare or a secondary infection and can quickly lead to sepsis and multi-organ involvement. Patients should be advised to report these symptoms immediately. For fevers 101.5 degrees or above, patients should seek immediate medical attention at the closest emergency department.

Pain Management
Severe Acute Pancreatitis:
Patients often need continued narcotics post discharge for several weeks due to ongoing inflammation and drain site pain. Pain medication needs should be assessed regularly in the ambulatory setting as weaning can often start a week or two post discharge, even if it is in very slow increments. Complications and flares are also common and may necessitate increased pain medications for a short duration. Assessment should include the patient’s ability to perform ADL’s and daily ambulation. If a patient is unable to ambulate due to pain, complications can ensue, namely respiratory complications that can lead to fluid in the lungs, atelectasis and pneumonia.

*See FAQ page for specific pain recommendations and treatment plans.

Chronic Pancreatitis:
Repeated bouts of inflammation and injury lead to permanent damage to the pancreas resulting in chronic pain and pain episodes. There are two common forms of pain in chronic pancreatitis patients, one is persistent pain with flare-ups or exacerbations of pain; and the other is relatively pain free durations with intermittent flare-ups and exacerbations. Management of chronic pancreatitis can be very challenging. The average patient gets only 30 percent reduction in pain over the long term and there is no data to suggest an improvement in function with opioid management.

*See FAQ page for specific pain recommendations and treatment plans.

Nausea or Vomiting Management
Pain and pain medications, diet intolerance and intestinal slowing due to inflammation related to pancreatitis can all cause nausea or vomiting. If nausea is persistent it is recommended to:

  • Reduce diet to clear liquids and advance to full liquids as tolerated
  • Low residue foods can also help decrease nausea as they dissolve easily in stomach
  • Avoid dairy
  • Maintain a low fat diet
  • Eat small, frequent meals
  • Use Zofran 4mg SL tab Q8 PRN
  • If the medication above doesn’t work, alternate Q6 Promethazine 25mg (PO or Rectal) and Zofran 4mg. (WARNING: Zofran can cause constipation)
  • If both medications listed above fail, then trial metoclopramide ONLY after discussing risks
  • IV fluids may be necessary if adequate oral intake cannot be sustained

Dehydration
Dehydration is a common issue with pancreatitis patients for the reasons listed in the nausea or vomiting section and often leads to re-admission to the hospital. Dehydration signs and symptoms and regular assessment of oral hydration by the patient and physician is important. Supplementing meals with nutritional drinks (example: Boost/Ensure) improves hydration.

Use this formula to calculate patient fluid needs:

      Body weight x 16 = number of milliliters (mL) of fluid your patient needs to drink per day
      Convert milliliters to cups: 240mL = 1 cup

For example:
Body weight = 125 pounds
125 pounds x 16 = 2000mL
2000mL divided by 240mL = 8 cups/day

Drain Management
Walled-off pancreatic necrosis often requires drain placement, which often remains after hospitalization. Unfortunately, drain issues can lead to complications or re-admissions.

The most frequent issues patients experience with drains are:

  • Resistance during flushing; inability to flush; saline coming out of the drain site
  • Drain accidentally pulled
  • Large fluctuations in the amount of drain output
  • Blood in drain
  • Skin infection around tube
  • Chills, sweats or fever greater than 101.5 degrees

Below are printable education materials given to patients to help them care for their drains. If you are unfamiliar with drain care, these resources should provide some guidance.

Depression or Anxiety Management
It is estimated that 50 percent of patients with chronic pancreatitis have depression, especially those dependent on opioid use. This must be recognized and addressed as part of any treatment plan. Repetitive exposure to stressors leads to psychological and behavioral response to chronic pain, which can be a vicious cycle. Ongoing psychological processes, i.e. catastrophizing, poor coping and low self-efficacy can worsen or sustain pain.

If you are concerned that your patient is suffering from depression, please strongly consider enlisting the help of a mental health professional.

Here are some examples of psychosocial interventions:

  • Cognitive behavioral therapy (CBT) can reduce arthritis pain, fibromyalgia, pancreatitis flare-ups and headaches
  • Hypnosis can improve acute and chronic pain across a variety of conditions, including pancreatitis
  • Meditation, yoga and mindfulness techniques reduce pain perception and suffering

Smoking and ETOH Cessation
Abstinence from alcohol is imperative as it is one of the leading causes of chronic pancreatitis. Smoking is equally imperative as it is an independent risk factor, resulting in pancreatic damage and functional impairment.