Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (127 page)

   Hereditary.

   Renal failure; renal transplantation.

   Miscellaneous (e.g., collagen vascular disease, pregnancy, ischemia, scorpion bites, parasites obstructing the pancreatic duct [
Ascaris
, fluke], Reye syndrome, fulminant hepatitis, severe hypotension, cholesterol embolization).

Laboratory findings due to complications
:

   Pseudocysts of the pancreas.

   Pancreatic infection or abscess diagnosed by increased WBC count, Gram staining, and culture of aspirate.

   Polyserositis (peritoneal, pleural, pericardial, synovial surfaces). Ascites may develop cloudy or bloody or “prune juice” fluid, 0.5–2.0 L in volume, containing increased amylase with a level higher than that of serum amylase. No bile is evident (unlike in perforated ulcer). Gram stain shows no bacteria (unlike infarct of the intestine). Protein >3 g/dL and marked increase in amylase.

   Adult respiratory distress syndrome (with pleural effusion, alveolar exudate, or both) may occur in approximately 40% of patients; arterial hypoxemia is present.

   DIC.

   Hypovolemic shock.

   Others.

   Prognostic Laboratory Findings

   On admission

WBC >16,000/μL

Blood glucose >200 mg/dL

Serum LD >350 U/L

Serum AST >250 U/L

Age >55 years

   Within 48 hours