Ranson Criteria for Acute Pancreatitis at Admission

The Ranson scoring system uses five parameters assessed at the time of admission to predict the severity of acute pancreatitis: age > 55 years, WBC count > 16,000/mm³, blood glucose > 200 mg/dL, serum LDH > 350 IU/L, and serum AST (SGOT) > 250 IU/L. The correct answer is 2, 3 and 4.

Analysis of Each Option

• Item 1 (WBC count > 15 × 10⁸/L): This is incorrect. The actual Ranson admission criterion for WBC is > 16,000 cells/mm³ (i.e., 16 × 10⁹/L), not > 15 × 10⁸/L. The value and unit given in this option do not match the standard cutoff used in the Ranson criteria, so this item is not one of the admission parameters.
• Item 2 (Blood glucose > 200 mg/dL): This is correct. Hyperglycemia above 200 mg/dL at admission is one of the five official Ranson admission criteria, reflecting stress-induced insulin resistance and pancreatic islet cell dysfunction.
• Item 3 (LDH > 350 units/L): This is correct. An elevated serum LDH above 350 IU/L at admission is a recognized Ranson criterion, indicating tissue necrosis and cellular injury.
• Item 4 (AST > 250 units/L): This is correct. Serum AST (SGOT) > 250 IU/L at admission is one of the five Ranson admission parameters, reflecting hepatocellular/pancreatic tissue damage and biliary involvement.

Why the Other Options Are Wrong

• Options containing Item 1 (1, 2 and 3; 1, 3 and 4; 1, 2 and 4) are incorrect because Item 1, as worded, does not correspond to the actual Ranson admission WBC criterion (> 16,000/mm³); the value/unit stated (> 15 × 10⁸/L) is not part of the validated scoring system.

Conclusion

The three parameters that genuinely correspond to Ranson's admission criteria among the given items are blood glucose > 200 mg/dL, LDH > 350 units/L, and AST > 250 units/L — i.e., items 2, 3 and 4. Hence, option "2, 3 and 4" is the correct answer.