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Mild acute pancreatitis improves faster with early aggressive hydration
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Patients with mild acute pancreatitis had more rapid clinical improvement with early aggressive intravenous hydration compared with standard hydration in a randomized trial.
“We found that aggressive intravenous hydration with [Lactated Ringer’s solution] increased the proportion of patients achieving clinical improvement within the first 36 [hours] after admission, increased the rate of clinical improvement, and reduced development of [systemic inflammatory response syndrome (SIRS)] and hemoconcentration,” investigators wrote.
To compare aggressive vs. standard hydration in the early management of acute pancreatitis, the researchers randomly assigned 60 patients without SIRS or organ failure to either aggressive or standard hydration within 4 hours of being diagnosed (mean age, 45 years; 23% with comorbidities).
The aggressive group received a bolus of 20 mL/kg then 3 mL/kg per hour, and the standard group received a bolus of 10 mL/kg then 1.5 mL/kg per hour. Patients in both groups were evaluated every 12 hours, and if hematocrit, blood urea nitrogen or creatinine were elevated, they received a bolus of 20 mL/kg then 3 mL/kg per hour. If these levels and epigastric pain were reduced, they received 1.5 mL/kg per hour and began a clear liquid diet.
Clinical improvement within 36 hours served as the primary endpoint, which was achieved by 70% of the aggressive group vs. 42% of the standard group (P = .03).
The aggressive group also achieved a higher rate of clinical improvement (adjusted HR = 2.32; 95% CI, 1.21-4.45), and were less likely to experience persistent SIRS (7.4% vs. 21.1%; aOR = 0.12; 95% CI, 0.02-0.94) or hemoconcentration (11.1% vs. 36.4%; aOR = 0.08; 95% CI, 0.01-0.49).
Finally, the researchers observed no signs of volume overload in any patients.
“Our findings suggest that aggressive hydration with [Lactate Ringer’s solution] is safe and should be the initial fluid therapy in patients who present with mild acute pancreatitis,” they concluded. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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