Metronidazole-Associated Pancreatitis

Sura, Michael E; Heinrich, Kathleen A; Suseno, Mira

doi:10.1345/aph.10021

Cited by 36 publications

(21 citation statements)

References 7 publications

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“…Otherwise, C-reactive protein (CRP) is a useful indicator for assessing severity and recommended to apply in clinical practice [23,24] . The most frequent complication of SAP in the aged in our study is ALI/ARDS (29 cases, 30.9%), followed by MODS (25,26.6%), electrolyte disturbances (21.3%), renal failure (17, 18.1%), pancreatic encephalopathy (16, 17.0%) and shock (16,17.0%). Currently, there are no specific examinations or unified diagnostic standards for pancreatic encephalopathy.…”

Section: Discussionmentioning

confidence: 56%

“…However, there is no clinical feature that can differentiate drug-induced pancreatitis from other factor causedpancreatitis. Drug-induced pancreatitis is usually diagnosed using the following criteria: pancreatitis developed during treatment, resolved following the discontinuation of the drug, and re-developed following re-challenge of the offending drug [17] . Because no causal factor for pancreatitis was found after the initial work-up, acute pancreatitis induced by Methotrexate was suspected in a 63 years old woman who took it for a week and her symptom was relieved after cessation of the drug.…”

Section: Discussionmentioning

confidence: 99%

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Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

Xin¹,

Hong²,

Luo³

et al. 2008

WJG

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AIM:To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥ 60 years of age). METHODS:We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007. RESULTS:In 169 patients with SAP, 94 were elderly and 16 died. Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly. Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young. The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners. The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score. Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups. Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (MODS). MODS was the main cause of death. CONCLUSION:The etiology of SAP in the elderly is quite different from that in the young. Biliary and unknown factors are main causes in the aged. The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young. It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

Xin¹,

Hong²,

Luo³

et al. 2008

WJG

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“…Clear evidence of association with pancreatitis exists for some drugs as furosemide and metronidazole, supported by animal experiments or data on the incidence of acute pancreatitis in drug trials 35 . Corticosteroids and ranitidine are also implicated to cause acute pancreatitis 4,19 .…”

Section: Discussionmentioning

confidence: 95%

Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features

Daher

Brunetta

Júnior

et al. 2003

Rev. Inst. Med. trop. S. Paulo

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SUMMARYHyperamylasemia has been reported in more than 65% of patients with severe leptospirosis, and the true diagnosis of acute pancreatitis is complicated by the fact that renal failure can increase serum amylase levels. Based on these data we retrospectively analyzed the clinical and histopathological features of pancreas involvement in 13 cases of fatal human leptospirosis. The most common signs and symptoms presented at admission were fever, chills, vomiting, myalgia, dehydratation, abdominal pain and diarrhea. Trombocytopenia was evident in 11 patients. Mild increased of AST and ALT levels was seen in 9 patients. Hyperamylasemia was recorded in every patient in whom it was measured, with values above 180 IU/L (3 cases). All patients presented acute renal failure and five have been submitted to dialytic treatment. The main cause of death was acute respiratory failure due to pulmonary hemorrhage. Pancreas fragments were collected for histological study and fat necrosis was the criterion used to classify acute pancreatitis. Histological pancreatic findings were edema, mild inflammatory infiltrate of lymphocytes, hemorrhage, congestion, fat necrosis and calcification. All the patients infected with severe form of leptospirosis who develop abdominal pain should raise the suspect of pancreatic involvement.

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“…However, there is no clinical feature that can differentiate druginduced pancreatitis from other factor caused-pancreatitis. Drug-induced pancreatitis is diagnosed by the following criteria: pancreatitis developed during treatments, resolved following the removal of the drug, and re-development following re-challenge of the offending drug [9] . A "definite" association can be made if the suspected drug meets all three criteria.…”

Section: Discussionmentioning

confidence: 99%

“…If a relationship is supported by not all three criteria, the drug is classified as having a "possible" association. A drug is classified as "questionable" if it is supported by inadequate or contradictory evidence [9] . The summaries of four reported cases and our present case and the association between pancreatitis and amiodarone are shown in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis and amiodarone: A case report

Chen

Chen²,

Leung³

2007

WJG

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Amiodarone, a class Ⅲ antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodaroneinduced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.

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Metronidazole-Associated Pancreatitis

Abstract: Very few cases of metronidazole-associated pancreatitis have been reported, and the long-term sequelae are unknown. However, if metronidazole or any other drug is suspected as the causative agent in pancreatitis, it should be discontinued and rechallenge should be avoided.

Cited by 36 publications

References 7 publications

Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features

Acute pancreatitis and amiodarone: A case report

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