Update on the strategy for intravenous fluid treatment in acute pancreatitis

Abstract

Fluid therapy/resuscitation is mandatory in acute pancreatitis due to the pathophysiology of fluid loss as a consequence of the inflammatory process. For many years, without clear evidence, early and aggressive fluid resuscitation with crystalloid solutions (normal saline solution or Ringer lactate solution) was recommended. Recently, many randomized control trials and meta-analyses on fluid therapy have revealed that high fluid rate infusion is associated with increased mortality and severe adverse events compared to those resulting from moderate fluid rates, and this has triggered a paradigm shift in fluid management strategies. Meanwhile, there is evidence to show that Ringer lactate solution is superior to normal saline solutions in this context. The purpose of this review is to provide an update on the strategies for intravenous fluid treatment in acute pancreatitis, including the type, optimal amount, rate of infusion, and monitoring guides. Recommendations from recent guidelines are critically evaluated for this review in order to reach the authors' recommendations based on the available evidence.

Recent Treatment Strategies for Acute Pancreatitis

“…Based on the available evidence from RCT results and several guidelines, we recommend a moderate fluid resuscitation strategy, starting with 1.5 mL/kg/h of LR infusion rate, preceded by bolus of 10-20 mL/kg over 2 h if patients have moderately severe to severe AP, signs of hypovolemia, acute kidney injury, or poor predictive indicators, such as hematocrit ≥ 44% or BUN > 25 mg/dL. The following fluid volumes are generally considered appropriate for the initial management of AP: 3 L at 24 h and 4-6 L at 48 h for mild AP; 3-4 L at 24 h and 6-8 L at 48 h based on clinical/laboratory parameters for moderate or severe AP [48].…”

Women’s Special Issue Series: Biomedicines

“…Fluid therapy is the standard therapy in acute pancreatitis, but the type of fluid to utilize is debated among clinicians [ 21 ]. The review and meta-analysis by Ocskay et al [ 22 ] aimed to summarize all the available evidence from randomized controlled trials comparing lactated Ringer’s solution with normal saline used in fluid therapy for acute pancreatitis patients, both adult and pediatric.…”