Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Organ failure or infected obstruction
Acute pancreatitis with hypoxaemia, shock, acute kidney injury or persistent systemic inflammatory response needs critical-care assessment; coexisting cholangitis adds an urgent need for biliary drainage.
Action: Resuscitate with repeated physiological review, provide analgesia and nutrition planning, investigate the cause, and obtain urgent HPB, endoscopy and critical-care input when organ failure or infected obstruction is suspected.
Synopsis
Diagnose acute pancreatitis, identify a biliary cause, grade organ failure, and time ERCP and cholecystectomy according to obstruction, cholangitis and disease severity.
Confirm acute pancreatitis from the compatible pain syndrome and raised lipase or amylase, using imaging when the diagnosis remains uncertain.
Look for gallstones with liver tests and ultrasound while also reviewing alcohol, medicines, calcium, triglycerides and other causes.
Support perfusion with individualised reassessed crystalloid, effective analgesia, oxygen when required and early enteral nutrition where oral intake is not possible.
Key red flags
Persistent hypoxaemia, hypotension, oliguria, rising lactate or confusion indicates severe acute pancreatitis and requires escalation.
Fever, jaundice and cholestasis with pancreatitis may represent cholangitis; routine delay for the pancreatitis to settle is unsafe when infection remains obstructed.
Organ failure
Hypoxaemia, shock and acute kidney injury define immediate severity and need for a higher level of monitoring.
Investigation priorities
01
Serum lipase or amylaseFirst step
Confirm biochemical pancreatic inflammation in a compatible syndrome.
Management branches
Worked case: mild biliary pancreatitisPrevent the second event
A patient has typical pain, lipase eight times the upper limit, gallbladder stones and falling liver tests; organ function is normal and symptoms improve over forty-eight hours.
Confirm acute pancreatitis and a likely gallstone cause while documenting that no cholangitis or persistent organ failure is present.
Provide analgesia, reassessed fluids and oral feeding as tolerated; avoid prophylactic antibiotics and routine urgent ERCP.
Key medicines
Paracetamol 500 mg tablets as a non-opioid analgesic componentFor an adult aged 16 years or over using this 500 mg tablet formulation, give 500–1,000 mg orally every 4–6 hours when required, leaving at least four hours between doses; give no more than four doses and do not exceed 4,000 mg, eight tablets, in 24 hours. Stop as acute pain resolves and reassess promptly if pain remains uncontrolled rather than exceeding the ceiling.Check every prescription and over-the-counter product for duplicate paracetamol. Use a lower patient-specific maximum with low body weight, malnutrition, chronic alcohol excess or hepatic impairment, and use an intravenous or alternative supervised plan if vomiting prevents absorption. Suspected overdose requires urgent toxicology assessment even if the person feels well.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.