Hemodynamic and metabolic impairment in acute pancreatitis

Twenty‐one patients with acute pancreatitis underwent evaluation of cardiovascular function and oxygen consumption; 5 of those who were critically ill had a further study of hormonal metabolism. The evaluation of hemodynamic parameters was made using a computer‐based cardiovascular program developed by Siegel et al. During the initial phase of the disease a reduction in vascular tone (relating cardiac index with total peripheral resistance) represented the basic abnormality seen in all patients, while a depression in ventricular function (relating left ventricular stroke work with central venous pressure) was observed in more than 40% of patients. With the progression of pancreatitis, cardiovascular monitoring identified a time, 5 days after admission, in which a clear deterioration of the hemodynamic parameters occurred. Beyond 5 days, all patients developed a hyperdynamic state with mild to severe deficiency of oxygen extraction. In the most seriously ill patients, oxygen consumption fell and peripheral shunting increased in a similar manner to that observed in septic and cirrhotic patients. At this time a Survival Index permitted recognition of those patients at high risk of rapid deterioration who might benefit from emergency surgical therapy. In 5 patients who developed a hyperdynamic unbalanced state, a marked reduction in oxygen consumption was associated with significantly increased serum levels of insulin, glucagon, aromatic amino acids, octopamine, and phenylethanolamine. While false neurotransmitters may be invoked in explanation of peripheral vascular abnormalities, the cause of impairment in oxygen extraction remains unclear.