Question

A 38-year-old man presents with sudden onset of acute upper abdominal pain since the previous night associated with nausea, several episodes of vomiting, and weakness. The pain is mostly in the epigastric region with constant, severe, and steady radiation to the back. He also has a low grade fever since this morning without any chills. He denies diarrhea or dysuria. His past history is significant for hypertension, for which he takes amlodipine 10 mg daily and enalapril 5 mg daily. He has smoked half a pack of cigarettes daily for the past 12 years. He initially denies drinking alcohol except on the weekends occasionally, but on further and repeated questioning he says he drinks 3-4 beers daily and had been drinking continuously for the last 2 days with his friends while watching sports on TV. Family history is unremarkable.

On examination he has a temperature of 100.6° F, pulse 106/minute, BP 150/92 mm Hg, and respiratory rate is 20/minute. There is no pallor, icterus, cyanosis, or lymphadenopathy. Mucus membranes are dry, and skin is somewhat clammy. Lungs are clear, and heart sounds normal except for sinus tachycardia. Abdominal exam reveals diffuse tenderness in the epigastric and right as well as left upper quadrants. There is some distension and mild guarding in the upper abdomen. Bowel sounds are hypoactive, but there is no ascites or hepatosplenomegaly. Rectal exam is normal. Labs reveal Hb 15g%, WBC 14,500/uL, platelets 400,000/uL, AST 42 U/L, ALT 36 U/L, AP 26 U/L, amylase 3600 U/L, lipase 546 U/L, BUN 25 mg/dL, creatinine, 1.5 mg/dL, bilirubin 1.2 mg/dL, and random blood sugar 110 mg/dL.

Which of the following is one of the predictors of acute pancreatic necrosis if present at diagnosis along with 2 other factors?

1. Age over 50 years
2. WBC count more than 16,000/uL
3. Blood glucose over 180mg/dL
4. Serum LDH over 300 U/L
5. AST more than 200 U/L

Answer 1

The predictor of acute pancreatic necrosis at diagnosis when present with two other factors is serum LDH over 300 U/L.

Step-by-step explanation:

The clinical scenario provided points to the diagnosis of acute pancreatitis, which is the inflammation of the pancreas. Among the listed options, the predictor of acute pancreatic diagnosis, when present along with two other factors, is option 4, serum LDH over 300 U/L.

Elevated levels of serum lactate dehydrogenase (LDH) can indicate tissue damage and necrosis, and when high, is a marker of a more severe case of pancreatitis. The other laboratory values provided, such as white blood cell count, can also be relevant in assessing the severity of pancreatitis but do not meet the specific criteria mentioned in the question.