title: Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis.
abstract: OBJECTIVE
  Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. We performed a randomized controlled trial to evaluate the impact of a goal-directed fluid resuscitation protocol on systemic inflammation in patients with acute pancreatitis. We then determined the impact of resuscitation with lactated Ringer's solution, compared with normal saline.
  
  
  METHODS
  We performed a randomized controlled trial of 40 patients with acute pancreatitis at 3 New England hospitals from May 2009-February 2010. Patients received goal-directed fluid resuscitation with lactated Ringer's solution, goal-directed fluid resuscitation with normal saline, standard fluid resuscitation with lactated Ringer's solution, or standard fluid resuscitation with normal saline. Systemic inflammation was measured on the basis of levels of systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) level after 24 hours.
  
  
  RESULTS
  The volumes of fluid administered during a 24-hour period were similar among patients given goal-directed or standard fluid resuscitation (mean, 4300 vs 4600 mL, respectively; P = .87). Goal-directed resuscitation did not significantly reduce incidence of SIRS, compared with standard resuscitation (11.8% vs 13.0%, respectively; P = .85) or levels of CRP after 24 hours (87.1 vs 69.2 mg/dL, respectively; P = .75). By contrast, there was a significant reduction in SIRS after 24 hours among subjects resuscitated with lactated Ringer's solution, compared with normal saline (84% reduction vs 0%, respectively; P = .035); administration of lactated Ringer's solution also reduced levels of CRP, compared with normal saline (51.5 vs 104 mg/dL, respectively; P = .02).
  
  
  CONCLUSIONS
  Patients with acute pancreatitis who were resuscitated with lactated Ringer's solution had reduced systemic inflammation compared with those who received saline.
authors.affiliation: Center for Pancreatic Disease, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. buwu@partners.org
authors.forename: Bechien U
authors.initials: BU
authors.lastname: Wu
authors.forename: James Q
authors.initials: JQ
authors.lastname: Hwang
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Gardner
authors.forename: Kathryn
authors.initials: K
authors.lastname: Repas
authors.forename: Ryan
authors.initials: R
authors.lastname: Delee
authors.forename: Song
authors.initials: S
authors.lastname: Yu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Smith
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006761:Hospitals; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009511:New England; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000628:therapy*; D010952:Plasma Substitutes / Q000008:administration & dosage; D000077325:Ringer's Lactate; D012965:Sodium Chloride / Q000008:administration & dosage*; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012965:Sodium Chloride; D002097:C-Reactive Protein