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• W3092834144 abstract "SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pancreatitis is a potentially life-threatening illness that results from a systemic inflammatory response caused by injury to the pancreas. While acute pancreatitis is most commonly due to biliary obstruction or alcohol, drug-induced pancreatitis from thiazide diuretics is a rare but important cause of acute pancreatitis. CASE PRESENTATION: A 68-year-old Caucasian female with past medical history of hypertension presented with 12 hours of abdominal pain, nausea, and vomiting. Her lipase was elevated to 1,924 U/L and computed tomography (CT) of the abdomen and pelvis showed severe acute pancreatitis with severe pancreatitis based on Ranson’s Criteria (leukocytosis, age, and glucose). Her pancreatitis work up was negative with normal abdominal ultrasound, lipid panel, IgG4, and no history of alcohol use. The patient’s home lisinopril-hydrochlorothiazide was thought to be the culprit of her pancreatitis, given she had no other risk factors. The patient improved with intravenous fluids. On hospital day 3, the patient developed tachypnea, tachycardia, and hypotension. She was found to have necrotizing pancreatitis on repeat CT scan. Her course was complicated by hypercarbic respiratory failure requiring intubation, anuric renal failure requiring dialysis, and septic shock requiring multiple vasopressors. She underwent percutaneous pancreatic drain placement. Her pancreatic fluid cultures grew Klebsiella pneumoniae, and she underwent treatment with meropenem. Her most recent follow-up three months post-admission demonstrated the patient continuing to require percutaneous drain and treatment with meropenem. DISCUSSION: Pancreatitis is an illness with reported mortality rates up to 55% when the patient has persistent organ failure (1). Our patient was previously healthy and had no common risk factors for pancreatitis; therefore, her pancreatitis was attributed to hydrochlorothiazide. A review of her other medications did not reveal any associations with pancreatitis. Hydrochlorothiazide has been studied and implicated in inducing pancreatitis in more than 10 published reports (2). The mechanism of hydrochlorothiazide-induced pancreatitis has been proposed to be due to direct ischemia, toxicity, and hypercalcemia (3). One case of lisinopril-hydrochlorothiazide was found on literature review. Like our patient, the etiology of the toxicity may have been more related to the hydrochlorothiazide, as no other case reports were found describing lisinopril-induced pancreatitis. Medication-induced pancreatitis is a rare diagnosis and should be considered in patients without common risk factors of pancreatitis. CONCLUSIONS: Clinicians should have a high index of suspicion for drug-induced pancreatitis in patients without common risk factors for pancreatitis. Reference #1: Buter A, Imrie CW, Carter CR, et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg. 2002;89:298. Reference #2: Trivedi CD, Pitchumoni CS. Drug-Induced Pancreatitis: An Update. J Clin Gastroenterol. 2005 Sep;39(8):709-16. Reference #3: J. Pickleman, F.H. Straus II, E. Paloyan. Pancreatitis associated with thiazide administration. A role for the parathyroid glands? Arch Surg. 1979;114:1013-1016 DISCLOSURES: No relevant relationships by Nelly Bellamy, source=Web Response Speaker/Speaker's Bureau relationship with Theravance Please note: $1001 - $5000 Added 06/12/2020 by Edward Charbek, source=Web Response, value=Honoraria No relevant relationships by Joseph Cumming, source=Admin input No relevant relationships by Abigail Go, source=Web Response" @default.
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• W3092834144 date "2020-10-01" @default.
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• W3092834144 title "HYDROCHLOROTHIAZIDE-INDUCED PANCREATITIS: A RARE CAUSE OF PANCREATITIS" @default.
• W3092834144 doi "https://doi.org/10.1016/j.chest.2020.08.851" @default.
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