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Correlation Between Pancreatitis,Pregnancy and Opiate Addiction
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Correlation Between Pancreatitis,Pregnancy and Opiate Addiction

Believe it or not, I have two friends who recently delivered dead babies in their 33-35 week of pregnancy.  The first was diagnosed as a "drug overdose" of vicodin. She did not take this medication on a daily basis but overdosed. The second one almost died herself of pancreatitis. She is a admitted drug addict to vicodin.  She has been honest from the beginning of her pregnancy about her addiction but never honest concerning the amount she has taken throughout her pregnancy or that she was taking "bootleg" pills.  Therefore the doctors appear puzzled as to her condition based on only the facts that they know.  She does not drink - - however they assume she is lying about that because of the pancreatitis.  Please explain to me the correlation between pregnancy, pancreatitis, and the addiction.  She takes approximately 20-40 vicodin a day (or more)even during pregnancy.  Knowing this can you explain how this medication can terminate a pregnancy and cause pancreatitis?
Please be specific because she insists that the doctors say the pain pills had nothing to do with her losing her baby or the pancreatitis. If they knew the amount she was ingesting would that make a difference in their opinion?  Explain the process that these drugs take and how this medication can be a direct cause for losing the baby and having pancreatitis.
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I am sorry to hear about your friends' loss.

20 to 40 vicodin per day is a huge amount of opiod narcotic.  The amount certainly would play a role in the babies' deaths.  

With that amount of vicodin, there is the risk the baby will receive a significant amount of the opiod.  Respiratory failure will result from large amounts of this drug.  

As for pancreatitis - again, large amounts of vicodin may contribute to this disease.  Pancreatitis can lead to infection and sepsis - which may contribute to harm to the fetus.  

I am not an OB, so my insight into this question is limited.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_
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Avatar_m_tn
I think maybe you intended to post your question to a doctor(?)
there are no doctors here, this is a patient to patient forum. For a doctor, you could post your question on the Gastroentrology forum, there is a doctor over there. I do know pancreatitis can be dangerous to the baby, I think the pancreatitis caused the problems in the pregnancy, as to if the pancreatitis was caused by the vicodin? It is possible I would imagine if she is taking 20 or 40 a DAY but you can get pancreatitis and not be taking vicodin also, so you'd need a lot more info to prove all the things are linked together.

I found this, maybe it will help. It could be the OTHER ingredients that are present in the "vicodin" she was taking.

"Are there any drugs that could be the cause of pancreatitis, if so what are they?

What is acute pancreatitis and what causes this?

12th April 1999

The pancreas has two important roles - one is to produce digestive enzymes that are passed into the digestive tract through a duct, and the other is to release hormones into the blood to control sugar levels. So the pancreas is both an exocrine and an endocrine gland. The pancreatic enzymes can become a danger to the pancreas itself if they become activated within the pancreatic tissues, and this is what happens in pancreatitis. The enzymes begin to digest the cells of the pancreas. Pancreatitis is an inflammatory process that produces different degrees of oedema, haemorrhage, and the destruction of pancreatic cells. It can be very serious. Acute pancreatitis means that the inflammation has suddenly appeared, whereas chronic pancreatitis means a more gradual process over a longer period of time. Pancreatitis is more common in adults than in children.

There are several possible causes:

disease of the biliary tract, for example: gall stones blocking the duct where it opens into the duodenum
alcoholism
trauma - bullet or knife wound
duodenal ulcer
hyperparathyroidism - over active parathyroid glands
hyperlipidaemia - abnormally high levels of lipids such as cholesterol in the blood
viral infection
certain drugs such as corticosteroids and thiazide diuretics.


The main symptom of pancreatitis is severe abdominal pain that is sudden in onset and continuous. It is usually felt in the midline just below the ribs, but may be biased to one side or the other depending on which part of the pancreas is most affected. The pain often radiates to the back, and the affected person may obtain some relief by sitting forward and holding the knees. However, analgesia is generally required. Nausea and vomiting often accompany the pain. The pain is usually severe for the first day and then decreases over following days as the inflammation subsides. Clinical examination may reveal a degree of shock, increased heart rate, increased white blood cell count and fever. The serum levels of amylase and other pancreatic enzymes may rise to five times their normal values during the first 24 to 72 hours - presumably the blood count you mention was for one of these enzymes.


Can pancreatitis affect the health of a child? My cousin was just diagnosed with pancreatitis, everyone keeps asking themselves why did the Gynecologist not know that she was ill? They did an emergency c-section and the baby is fine, but she is in critical/stable condition. Could this have been caused by the pregnancy?
13th May 1999

Although we are not in a position to comment directly on your cousin's situation - the health care team looking after her are able to do that - the following general comments may be of some help.

Pancreatitis during pregnancy can seriously affect the health of both the fetus and the mother (Chang et al, 1998; Ramin et al, 1995). If clinical signs of distress are detected in the baby that would prompt delivery by Cesarean section.

Diagnosing pancreatitis is not straightforward since similar symptoms can be generated by other disease processes as well, and it is necessary to distinguish between these before appropriate treatment can begin. Ultrasound examination of the abdomen and identification of elevated levels of amylase and lipase (enzymes produced by the pancreas) in the mother's blood are usually sufficient to confirm the diagnosis of pancreatitis.

Most cases of pancreatitis during pregnancy are caused by a bile stone passing down through the bile duct from the gall bladder and obstructing the opening into the duodenum shared with the pancreatic duct. It is unlikely that pregnancy causes pancreatitis - gall stones are usually present in the gall bladder before pregnancy begins - although pregnancy may conceivably influence the timing of the onset of pancreatitis and its subsequent course (Block, and Kelly, T.R. 1989). If the attack of pancreatitis during pregnancy is mild, recovery begins soon after delivery (Chen et al, 1995). If an operation is required to relieve the obstruction, keyhole surgery (endoscopic sphincterotomy) is effective and generally prevents recurrence of pancreatitis (Barthel, Chowdhury, and Miedema, 1998).

References

Barthel, J.S., Chowdhury, T., and Miedema, B.W. (1998) Endoscopic sphincterotomy for the treatment of gallstone pancreatitis during pregnancy. Surgical Endoscopy, 12(5), 394-399 (May).

Bernard, P., Lopez, J.F., Kitmacher, P., Doublier, C., and Peyretou, C. (1990) Acute pancreatitis and pregnancy. A recent case report. [Article in French] J Gynecol Obstet Biol Reprod (Paris), 19(8), 1006-1010.

Block, P., and Kelly, T.R. (1989) Management of gallstone pancreatitis during pregnancy and the postpartum period. Surgical Gynecology and Obstetrics, 168(5), 426-428 (May).

Chang, C.C., Hsieh, Y.Y., Tsai, H.D., Yang, T.C., Yeh, L.S., and Hsu, T.Y. (1998) Acute pancreatitis in pregnancy. Chung Hua I Hsueh Tsa Chih (Taipei), 61(2), 85-92 (Feb).

Chen, C.P., Wang, K.G., Su, T.H., and Yang, Y.C. (1995) Acute pancreatitis in pregnancy. Acta Obstet Gynecol Scand, 74(8), 607-610 (Sep).

Ramin, K.D., Ramin, S.M., Richey, S.D., Cunningham, F.G. (1995) Acute pancreatitis in pregnancy. American Journal of Obstetrics and Gynecology, 173(1), 187-191 (Jul).

Swisher, S.G., Hunt, K.K., Schmit, P.J., Hiyama, D.T., Bennion, R.S., and Thompson, J.E. (1994) Management of pancreatitis complicating pregnancy. American Surgery, 60(10), 759-762 (Oct).



Are there any drugs that could be the cause of pancreatitis, if so what are they?
28th January 2004

About 2% of all cases of pancreatitis are thought to be drug-induced to some degree (Wilmink and Frick, 1996; Kvande and Madsen, 2001). When ethanol abuse, smoking, and biliary disease are ruled out as aetiologies for pancreatitis, the possibility of drug-induced disease should be investigated (Underwood and Frye, 1993). More than 260 drugs have been implicated so far as possible causes or co-factors in pancreatitis (Battillocchi et al, 2002). The mechanisms suggested for drug-induced pancreatitis include pancreatic duct constriction; immunosuppression; cytotoxic, osmotic, pressure, or metabolic effects; arteriolar thrombosis; direct cellular toxicity; and hepatic involvement. However, much of the evidence so far comes from limited case studies, and clear evidence of an association requires rechallenge tests (in which the suspected drug is given again briefly after recovery from the first occurrence of pancreatitis), consistent case reports, evidence from animal experiments, and data on the incidence of acute pancreatitis during drug trials (Wilmink and Frick, 1996).

The following lists classify drugs and other agents according to published opinions about their degree of possible involvement in pancreatitis. Some agents appear in more than one list, indicating that there are different opinions about the level of association.

Agents reported to have a definite association with pancreatitis:

2',3'-dideoxyinosine (Lankisch, Droge, and Gottesleben, 1995)
asparaginase (Underwood and Frye, 1993)
azathioprine (Underwood and Frye, 1993; Lankisch, Droge, and Gottesleben, 1995; Eland et al, 1999; Andersen, Sonne, and Andersen, 2001)
clomipramine (Andersen, Sonne, and Andersen, 2001)
cimetidine (Eland et al, 1999)
didanosine (Underwood and Frye, 1993)
enalapril (Maringhini et al, 1997)
furosemide, frusemide (Underwood and Frye, 1993; Lankisch, Droge, and Gottesleben, 1995)
hydrochlorothiazide (Lankisch, Droge, and Gottesleben, 1995)
interferon-alpha (Eland et al, 1999)
mercaptopurine (Underwood and Frye, 1993)
mesalazine (Lankisch, Droge, and Gottesleben, 1995; Andersen, Sonne, and Andersen, 2001)
methyldopa (Eland et al, 1999)
metronidazole (Eland et al, 1999)
oestrogens (Underwood and Frye, 1993; Lankisch, Droge, and Gottesleben, 1995)
olsalazine (Eland et al, 1999)
oxyphenbutazon (Eland et al, 1999)
pentamidine (Underwood and Frye, 1993)
rifampicin (Lankisch, Droge, and Gottesleben, 1995)
selective serotonin reuptake inhibitors (SSRIs) (Kvande and Madsen, 2001)
simvastatin (Andersen, Sonne, and Andersen, 2001)
sulfonamides (Underwood and Frye, 1993)
sulindac (Underwood and Frye, 1993)
tetracyclines (Underwood and Frye, 1993)
thiazides (Underwood and Frye, 1993)
valproic acid/valproate (Asconape et al, 1993; Underwood and Frye, 1993; Andersen, Sonne, and Andersen, 2001)

Agents reported to have a probable association with pancreatitis:

allopurinol (Andersen, Sonne, and Andersen, 2001)
angiotensin-converting enzyme inhibitors (Andersen, Sonne, and Andersen, 2001)
antiviral agents used in acquired immunodeficiency syndrome therapy (Andersen, Sonne, and Andersen, 2001)
cimetidine (Underwood and Frye, 1993)
clozapine (Underwood and Frye, 1993)
codeine (Andersen, Sonne, and Andersen, 2001)
corticosteroids (Underwood and Frye, 1993)
didanosine (Andersen, Sonne, and Andersen, 2001)
doxycycline (Eland et al, 1999)
enalapril (Eland et al, 1999)
endoscopic retrograde cholangiopancreatography contrast media (Underwood and Frye, 1993)
famotidine (Eland et al, 1999)
griseofulvin (Andersen, Sonne, and Andersen, 2001)
ibuprofen (Eland et al, 1999)
interferon (Andersen, Sonne, and Andersen, 2001)
lipid-reducing agents (Andersen, Sonne, and Andersen, 2001)
lithium (Andersen, Sonne, and Andersen, 2001)
maprotiline (Eland et al, 1999)
mesalazine (Eland et al, 1999)
methyldopa (Underwood and Frye, 1993)
metronidazole (Underwood and Frye, 1993)
MMR (measles/mumps/rubella) vaccination (Andersen, Sonne, and Andersen, 2001)
oestrogen preparations (Andersen, Sonne, and Andersen, 2001)
paracetamol (Andersen, Sonne, and Andersen, 2001)
salicylates, 5-acetylsalicylic acid agents (Underwood and Frye, 1993; Andersen, Sonne, and Andersen, 2001)
sulindac (Eland et al, 1999)
ticlopine (Andersen, Sonne, and Andersen, 2001)
valproate (Andersen, Sonne, and Andersen, 2001)
zalcitabine (Underwood and Frye, 1993)

Agents reported to have a questionable association with pancreatitis:

acetaminophen (Underwood and Frye, 1993)
cyclosporine (Underwood and Frye, 1993)
cytarabine (Underwood and Frye, 1993)
erythromycin (Underwood and Frye, 1993)
roxithromycin (Underwood and Frye, 1993)
ketoprofen (Underwood and Frye, 1993)
metolazone (Underwood and Frye, 1993)
octreotide (Underwood and Frye, 1993)

References

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Avatar_m_tn
Duh! I thought this was the other forum, sorry
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Avatar_n_tn
I thought this was the Gastro Forum?  How do I get a doctor to explain this to me?
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Avatar_m_tn
You are in the right place, I was the one who had the wrong forum, I thought thiswas anotherforum,sorry about that.
Sometimes it can take awhile to get an answer from the doctor. A day, a few days, it depends on how busy they are I think so you have to be patient.
I am sorry about your friends and the babies.what a tragedy.
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Avatar_f_tn
just a thought but, vicodan,oxycodone (sythetic opiates) have not been a "household" name like they are today, is it possible that there is a correlation between abusing these drugs and pancreas or bile duct problems??  In the past the opiate that was abused was heroin, we may be still learning about long term effects of synthetic opiates!!  Wasn't codeine on that list?
Just a thought, I think we are all different,and while alcohol must have a impact on many maybe some of these opiates have an effect on a few?
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HI All! I can't believe I actually found something about this.  It seemed like I was the only one!! I developed severe acute pancreatitis when I was 34 weeks pregnant! Although I never drink alcohol and do not take any narcotics.  I was told my triglycerides were in the thousands and that is what triggered my attack.  I developed severe pain in the left side of my abdomen and was taken to the ER.  They ended up having to take my daugter emergency c section, she was in NICU for about a week, but luckily she ended up being perfect.  I was not so fortunate.  I spent 2 weeks in ICU.  My family was told I had a 10% chance of surviving, but luckily here i am! I went into renal failure, resp failure, pretty much all of my organs have been effected. I've spent a total of 8 months in the hospital. (including a 3 month stay when my daughter was a newborn) I've had to have 7 surgeries since then due to all the effects of pancreatitis, but I'm still here and have a beautiful 23 month old daughter.  I now have chronic pancreatitis because the damage was so severe to my pancreas, but things could have turned out so much worse.
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