Tuesday, 25 August 2015

Ranson criteria

The Ranson criteria predicting the severity of acute pancreatitis. 
Parameters used:At admission
:Age in years > 55 years
White blood cell count > 16000 cells/mm3
Blood glucose > 10 mmol/L (> 200 mg/dL)
Serum AST > 250 IU/L
Serum LDH > 350 IU/LWithin 48 hours:
Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
Hematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit (negative base excess) > 4 mEq/L
Sequestration of fluids > 6 L
The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to non-gallstone pancreatitis.
For gallstone pancreatitis, the parameters are:
At admission:Age in years > 70 years
White blood cell count > 18000 cells/mm3
Blood glucose > 12.2 mmol/L (> 220 mg/dL)
Serum AST > 250 IU/LSerum LDH > 400 IU/LWithin 48 hours:
Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
Hematocrit fall > 10%Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL)
after IV fluid hydrationBase deficit (negative base excess) > 5 mEq/L
Sequestration of fluids > 4 LThis can be remembered by the mnemonic "WALLS FOr CHUB" At admission:W = WBCA = AgeL = LDHL = Liver enzyme (AST)S = SugarAfter 48hrs:F = Fluid requirementO = pA02C = CalciumH = HaematocritU = UreaB = Base deficitThis can also be remembered by the pneumonic "GA LAW" for the on admission parameters and "C HOBBS" (as in Calvin and Hobbes) for the 48 hour parameters.
Alternatively, pancreatitis severity can be assessed by any of the following:
APACHE II score ≥ 8Organ failure
Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhancedCT)
Interpretation
If the score ≥ 3, severe pancreatitis likely.
If the score < 3, severe pancreatitis is unlikely Or
Score 0 to 2 : 2% mortality
Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality
Score 7 to 8 : 100% mortality..

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