Case report: acute pancreatitis induced by Clozapine.

Two percent of acute pancreatitis are drug induced. In the present paper, we reported the case of a 39 year-old patient with chronic-hallucinatory schizophrenia who developed symptomatic pancreatitis during the clozapine dose titration performed to reach the therapeutic range. Diagnosis of pancreatitis was suggested by clinical examination and abnormal laboratory values of pancreatic enzymes and confirmed by C-T scan and ultrasonography. The causal incrimination of clozapine in this case seems likely as all other possible causes of pancreatitis were excluded, as AP developed shortly after the introduction of the drug and as the pancreatic enzymes normalized after clozapine was stopped. No rechallenge to confirm the causal relationship was however attempted. So far, only eight cases of acute pancreatitis have been reported in association with clozapine use. Clozapine is an atypical antipsychotic drug which belongs to the chemical class of dibenzodiazepines. The mechanism by which clozapine could produce acute pancreatitis remained unclear. Nevertheless, we advocate a careful biological follow-up (measuring periodically the concentrations of amylase, lipase and triglycerides) during the treatment by clozapine.

Care coordinator--blending roles to improve patient outcomes.

A care coordinator blends aspects of the case manager and clinical specialist roles with those of a unit-based staff developer. In this position, the nurse facilitates critical pathways; coordinates care with the patient, family, ancillary staff and community services; delivers unit-based staff-development programs; and acts as mentor, staff resource person and physician liaison. The development and utilization of this professional nursing role in a community hospital is outlined.