MCQ 9

A 35-year-old alcoholic male is admitted for nausea, vomiting, and abdominal pain that radiates to the back. The laboratory value that suggests a poor prognosis in this patient is
a. Elevated serum lipase
b. Elevated serum amylase
c. Leukocytosis of 20,000/μm
d. Diastolic blood pressure greater than 90 mmHg

Answer and explanation :

The answer is c.

The Ranson criteria are used to determine prognosis in acute pancreatitis. Factors that adversely affect survival include : 

1.Age greater than 55 years,

2. leukocytosis greater than 16,000/μm,

3. glucose greater than 200 mg/dL, 

4. LDH greater than 400 IU, and 

5.AST greater than 250 IU/L. 

After the initial 48 h, a fall in hematocrit, hypocalcemia, hypoxemia, an increase in BUN, and hypoalbuminemia are also poor prognostic findings. Hypotension with systolic BP less than 90 mmHg is also a poor prognostic sign; diastolic hypertension is not correlated with prognosis.