Intravenous fluids in acute pancreatitis: a prospective study

Authors

  • Jithin Sony Department of Surgery, Pushpagiri Institute of Medical Science, Thiruvalla, Kerala, India
  • Ann Sunny
  • Anthony Prakash Rozaria Department of General Surgery, St. John’s Medical College, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20204138

Keywords:

Acute pancreatitis, Fluid resuscitation, Systemic inflammatory response syndrome

Abstract

Background: Fluid therapy is the mainstay of treatment in the management of acute pancreatitis. Most guidelines recommend aggressive fluid therapy in the initial 48-72 hours. We aimed to compare the occurrence, persistence or worsening of systemic inflammatory response syndrome (SIRS) and occurrence organ failure in patients with acute pancreatitis receiving normal and high volume fluid therapy in the first 24 hours.

Methods: This was a prospective observational study. Consecutive adult patients admitted with acute pancreatitis were included in the study. SIRS was defined according to the criteria. Organ failure and local complications were defined according to Atlanta classification. Patients were divided into two groups according to the rate of fluid administered in the initial 24 hours: Normal volume group which received fluids at a rate <150 ml/hour and high volume group >150 ml/hour.

Results: A total 60 patients were included in the study with 30 each in the two groups. Persistence or worsening of SIRS at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.076). Organ failure at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.074). Incidence of local complications equal in both group.

Conclusions: Our study did not show any statistically significant difference in outcomes in patients with acute pancreatitis receiving normal or high volume fluids in the initial 24 hours. Further multi-centric randomised control trials are required to analyze the outcomes of high and normal volume fluid resuscitation in acute pancreatitis.

References

Dhiraj Yadav and Albert B. Lowenfels, The Epidemiology of Pancreatitis and Pancreatic Cancer. Gastroenterology 2013 Jun; 144(6): 1252-1261.doi:10.1053/j.gastro.2013.01.068

Baker RJ. Editor's Comment. Skandalakis LJ, Rowe JS Jr, Gray SW, Skandalakis JE. Surgical anatomy of the pancreas. In: Nyhus LM, Baker RJ. Mastery of Surgery (2nd ed). Boston: Little, Brown, 1992, pp. 995-1009.

Roberts, S. E., Akbari, A., Thorne, K., Atkinson, M. and Evans, P. A. (2013), The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors. Aliment Pharmacol Ther, 38: 539–548. doi:10.1111/apt.12408

Whitcomb DC. Acute pancreatitis. N Engl J Med 2006; 354:2142-2150 May 18, 2006 DOI: 10.1056/NEJMcp054958

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006; 101:2376-2400.

de-Madaria E, Soler-Sala G, Sánchez-Payá J, Lopez-Font I, MartÃnez J, Gómez-Escolar L et al. Influence of Fluid Therapy on the Prognosis of Acute Pancreatitis: A Prospective Cohort Study. Am J Gastroenterol. 2011;106(10):1843-1850.

Dufour MC, Adamson MD. The epidemiology of alcohol-induced pancreatitis. Pancreas. 2003 Nov;27(4):286-90

Lankisch, Paul Georg; Assmus, Christine; Lehnick, Dirk; Maisonneuve, Patrick; Lowenfels, Albert B. Acute pancreatitis: Does gender matter? Digestive Diseases and Sciences46.11 (Nov 2001): 2470-4.

Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006 Nov;33(4):323-30.

Premkumar R, Phillips AR, Petrov MS, Windsor JA. The clinical relevance of obesity in acute pancreatitis: targeted systematic reviews. Pancreatology. 2015 Jan-Feb;15(1):25-33. doi: 10.1016/j.pan.2014.10.007. Epub 2014 Oct 27

de-Madaria E, Soler-Sala G, Sanchez-Paya J, Lopez-Font I, Martinez J, Gomez-Escolar L et al. Influence of Fluid Therapy on the Prognosis of Acute Pancreatitis: A Prospective Cohort Study. Am J Gastroenterol. 2011;106(10):1843-1850.

Mao EQ, Tang YQ, Fei J, Qin S, Wu J et al. Fluid therapy of acute severe pancreatitis in acute response stage. Chin Med J 2009; 122:169-73.

Warandorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. ClinGastroenterolHepatol 2011; 9:705-709.

Gardner TB, Vege SS, Chari ST, Petersen BT, Topazian MD, Clain JE, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 2009; 9:770-6.

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Published

2020-09-23

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Original Research Articles