Serum amylase is 2414 U/L with a serum lipase of 1090 U/L. You diagnose your patient as having acute pancreatitis. (See card: Pancreatitis)

Mrs M's old hospital records have now arrived which document prior emergency department visits for abdominal pain and treatment of a number of lacerations and a fractured wrist. In most of these visits she was noted to be intoxicated. This confirms your diagnosis of acute on chronic pancreatitis secondary to alcohol abuse. After inserting a subclavian central line for volume monitoring and inserting a nasogastric tube you admit her to the high dependency unit and continue to fluid resuscitate her. You have ordered gravol and demerol for control of pain and nausea.