Pancreatitis
Presentation:
A 26-year-old male, J.S., presents to the hospital ED via EMS with complaints of abdominal pain currently 6/10, nausea and vomiting, with dark tea colored urine that “smells like blood.” This started 2.5 hours ago and the pain comes in waves with the worst pain being 10/10 and the best being 6/10. This morning the patient participated in a biathlon and has a long history of exercising 2-4 hours per day. The patient denies any chronic illness/disease. Vitals are as follows: HR 48, BP 152/98, Temp: 36.7, RR16, SaO2 99% RA. Patient denies being lightheaded, dizzy, or short of breath. The patient has two large bore IVs started with a 2L bolus of NS started, blood and urine are sent to the lab. Pt denies current nausea and refuses pain meds at this time.
Differential Diagnosis:
Urinary Tract Infection, Myoglobinuria, Kidney Stones
Diagnostics:
CBC: normal
UA: positive for blood
BMP: normal
EKG: normal sinus rhythm
At this point it doesn’t look like this patient has any of the original differential diagnoses that were originally thought to be the most likely. Therefore another list was generated. At this point in time the patient now is nauseous and vomiting and his pain is a 9/10. He continues to void dark tea colored urine. Maintenance fluid is hung at 150ml/hr.
Updated Differential Diagnosis:
Bowel Ileus or Perforation, Pancreatitis
Diagnostics:
Abdominal CT: possible edema surrounding the pancreas. Therefore we sent a Lipase. Serum Lipase: 15,000.
Diagnosis, Treatment and Outcome:
This patient has pancreatitis. He is given pain meds and is ordered to have nothing by mouth. He is sent to the floor for fluids, pain management and to monitor his vitals and his pancreas. His expected stay is 2-5 days and his outcome should be good.