Figure 1. Algorithm to categorize severity of pediatric acute pancreatitis (AP) and recommended treatment of HTG. Modified from (3).
aPresence of at least 2 of the following 3 criteria: 1) abdominal pain compatible with pancreatic origin; 2) amylase and/or lipase at least 3 X ULN; and 3) imaging suggestive of/compatible with pancreatic inflammation. (2)
bCriteria of organ dysfunction as per the International Pediatric Sepsis Consensus [Modified from (16).
I. Cardiovascular Dysfunction
a. One or more of the following despite administration of isotopic IV fluid bolus > 40 mL/kg in 1 hr.
• Hypotension – Decrease in BP < 5th% for age or systolic BP < 2 SD below normal for age. • Need for vasoactive drug to maintain BP in normal range (dopamine > 5 mcg/kg-1/mL-1 or dobutamine, epinephrine, or norepinephrine at any dose).
b. Two of the following:
• Unexplained metabolic acidosis (Base Deficit > 5 mEq/L).
• Increased arterial lactate > 2 X ULN.
• Oliguria: urine output < 0.5 mL/kg-1/hr-1. • Core to peripheral temperature gap > 3° C.
II. Respiratory Dysfunction
a. One or more of the following in absence of pre-existing lung disease or cyanotic heart disease.
• PaO2/FIO2 < 300 in absence of cyanotic heart disease or pre-existing lung disease. • PaCO2 > 65 torr or 20 mmHg over baseline PaCO2.
• Proven need or > 50% FIO2 to maintain saturation > 92%.
• Need for non-elective mechanical ventilation.
III. Renal Dysfunction
• Serum creatinine ≥ 2 X ULN for age; or
• 2-fold increase in baseline creatinine.