pancreatitis and demerol

Specialties Med-Surg

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Had a young patient the other day with pancreatitis, pretty much from drinking so much. Patient was receiving Dilaudid 2 mg Q 4 hours prn pain. Was getting it every four hours pretty much but would freak out everytime I was ten minutes late or so. (God forbid I have six other patients that need me) Called the house officer to see patient about pain meds, the doc came up and started saying something about Demerol being the drug of choice for pancreatitis because of dilaudid and morphine and the spinchter of oddi. I started to cite Nursing 2007 which stated that Dilaudid was the med of choice for pancreatitis, b/c it was believed that all opiods cause relaxation of the spinchter of oddi but dilaudid is preferred because demerol can cause seizures. (Demerol convertes to the antimetabolite normeperidine, which is known to cause seizures.) I also pointed out that he was already at risk for seizures due to his drinking. Anyway intern left the meds alone, even though I wanted an increase in either frequency or dose. Patient was in pain evidenced by increased b/p and lipase of 1,000. Had to wait for attending to make rounds at 5pm. Anyway wanted to know what your thoughts were on dilauded or demerol for pancreatitis.

Morphine may be the drug of choice, but Demerol has been the medication of choice here. It is in PCA form, loading dose, then q mg/hr as ordered by physician with input from pain doctor.

I hope Demerol never "goes away" both my daughters have violent reactions to morphine, one almost died, so this is definately not good news for me.

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I have read an article about Demerol as the drug of choice for pancreatitis. Demerol, as we learned in Nursing school has metabolites (normeperidine)that the body can not get rid off and causes seizures. Morphine, on the other hand, it is believe to cause spasms at the sphincter of oddi. Hydromorphone is 5x stronger than Morphine. Morphine IV half-life 2-3hr. Dilaudid 2.7 hr. Every 3 hr or PCA pump would probably be best for a pt with Pancreatitis...In my opinion.

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Specializes in Critical Care. CVICU. Adult and Peds PACU..

Hey guys... I know this posting is old but I am in my 3rd block of nursing school and we were taught that demerol is the drug of choice because morphine causes the sphincter of oddi to spasm thus exacerbating the symptoms.

We are also told that demerol is being phased out for the use of pain because of the toxic build up of metabolites. However, for pancreatitis, demerol is the drug of choice.

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In my hospital, IV demerol is no longer available. The PCA/IV pain meds are morphine, dilaudid or fentanyl.

I haven't seen any form of demerol used in over a year.

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Specializes in Home Health.

I have never heard of so many hospitals not using Demerol! WOW, didn't know that information. We use Dilaudid and Morphine for pancreatitis, depending on the ordering doctor.

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Specializes in DD, HHC, Med Surg, PCU, Resource.

this comes straight from brunner's and suddarth 11th ed.

the use of morphine was avoided in the past because of concern that it could cause painful spasms of the sphincter of oddi and worsen pancreatitis. however, there is no evidence that this affects the outcome of the disease. meperidine (demerol) had been the medication of choice, although all opioids stimulate the sphincter of oddi to some degree. there is no clinical evidence to support the use of meperidine for pain relief in pancreatitis, and, in fact, accumulation of its metabolites can cause cns irritability and possibly seizures. the current recommendation for pain management is the use of morphine (reddy & long, 2004; swaroop et al., 2004). hydromorphone (dilaudid) may also be effective, but more research is needed to identify the best option for pain management in the patient with acute pancreatitis. antiemetic agents may be prescribed to prevent vomiting.

i am still confused...but on my most recent clinical, i had a pt in with acute pancreatitis and morphine was what was ordered for her. so which is it? i am still a student...just 8 weeks left for my asn...and i fear questions like this on the nclex....:)

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Had a young patient the other day with pancreatitis, pretty much from drinking so much. Patient was receiving Dilaudid 2 mg Q 4 hours prn pain. Was getting it every four hours pretty much but would freak out everytime I was ten minutes late or so. (God forbid I have six other patients that need me) Called the house officer to see patient about pain meds, the doc came up and started saying something about Demerol being the drug of choice for pancreatitis because of dilaudid and morphine and the spinchter of oddi. I started to cite Nursing 2007 which stated that Dilaudid was the med of choice for pancreatitis, b/c it was believed that all opiods cause relaxation of the spinchter of oddi but dilaudid is preferred because demerol can cause seizures. (Demerol convertes to the antimetabolite normeperidine, which is known to cause seizures.) I also pointed out that he was already at risk for seizures due to his drinking. Anyway intern left the meds alone, even though I wanted an increase in either frequency or dose. Patient was in pain evidenced by increased b/p and lipase of 1,000. Had to wait for attending to make rounds at 5pm. Anyway wanted to know what your thoughts were on dilauded or demerol for pancreatitis.
I'm a RN & suffer from SOD sphincter of Oddi disorder & chronic pancreatitis. Demerol is the preferred drug for pain management but the hospitals here have done away w/ it too. Morphine does not work as well as dilaudid but neither work near as well as Demerol. Phenagren is also better than zofran b/c it not only helps w/ the nausea but the pain. I'm sad that they are also phasing it out. That is going to be a sad day. To help others understand how painful pancreatitis is thus helping you empathize with your patients, I can only discribe it as have an ice cream scoop scooping & tearing my insides a part. What can we do as patient advocates to help the hospital understand the needs of our patients. Btw I got SOD due to a congenital anomaly thus causing my chronic pancreatitis & not alcoholism.
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Specializes in ER, progressive care.
Hi! Great question and controversial.

I am in the process of studying for the CCRN certification which I will take in the next month or so. In my study material, the correct answer for the test is to use Demerol for Pancreatitis because Morphine causes spasms in the Sphincter of Oddi. However, in all my resources, they indicate that research has shown no difference between Morphine and Demerol (or Dilaudid) in the degree of spasm in the Sphincter of Oddi. Also, I don't see anything about the seizure potential of Demerol in my resources, at least not for the CCRN exam. I was told that the correct answer on the CCRN exam at this point in time is that only Demerol is the drug of choice for Pancreatitis, however, that is clearly outdated. In my institution I have seen Dilaudid used. Occasionally, a Demerol PCA will crop up, but very rarely.

My material also says something about a neurolytic block of the celiac plexus for severe persistent pain. (I'm not sure exactly what that would be--some kind of epidural??)

We must be using the same resource ;)

This is from a 2002 source, but:

However, on repeated dosing, patients (especially those with renal impairment) will experience an accumulation of the toxic metabolite, normeperidine. Normeperidineis a very weak analgesic (less than 1/3 the potency of racemic meperidine) and a potent central nervous system irritant. Symptoms of normeperidine accumulation progress from irritability to tremors and myoclonus, to generalized seizures.

Meperidine Use Guideline

Even in patients with good renal function, normeperedine metabolites can accumulate and cause seizures.

Our doctors at the hospital will stay away from Demerol because of increased potential of seizures. It's all about the morphine and dilaudid. We only have one doctor who routinely prescribes Demerol (along with Ativan, something about helping the heart - this guy is a cardiologist) - but this MD always does EVERYTHING differently.

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Specializes in ER, progressive care.
Phenagren is also better than zofran b/c it not only helps w/ the nausea but the pain. I'm sad that they are also phasing it out. That is going to be a sad day.

I like phenergan. I think it has a better effect on patients than Zofran. Our hospital still uses phenergan, but under no circumstances are we to give it IV because it is so caustic to the veins. At other hospitals (when I was a student) we would routinely give phenergan, we would just dilute it. Even with dilution, my facility does not want to have it given IV. If the doctor insists, then the doctor needs to give it IV himself. :uhoh3: Phenergan must be administered PO or by deep IM at my facility.

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