1. Acute Pancreatitis
2. Must have:
Gallstones (40%)
Alcohol ( 35%)
One of:
ERCP 9iatrogenic)
Trauma
Drugs
3. Normal anion gap metabolic acidosis with partial compensation
anion gap = 12
Expected CO2 = 35 mmHg
likely hyperchloraemic, due to 0.9% saline therapy
4. GI losses – diarrhoea
Saponification – deposition of K (and Ca ) salts
shift and renal losses
5. Biliary obstruction (ERCP)
Early necrotic infection
Multi-organ failure with deterioration despite optimal critical care
Extensive (>50%) sterile necrosis
Peritonitis (search for alternate diagnosis -?laparoscopy)
Significant haemorrhage (embolization)