Current controversies in fluid resuscitation in acute pancreatitis: a systematic review.
Acute pancreatitis (AP) is a common inflammatory disorder of the pancreas resulting in considerable morbidity and mortality. Aggressive intravenous fluid resuscitation generally is recommended in all patients with AP and remains the cornerstone of management of these patients. However, the optimal rate, type, and the goal of resuscitation remain unclear. The purpose of this review was to give an insight about the pathophysiologic alterations in the pancreatic microcirculation that occur in AP, the markers for early recognition of severity of pancreatitis, the optimal fluid, and timing and extent of fluid resuscitation. An early elevated hematocrit, blood urea nitrogen, or creatinine should prompt clinicians to institute more intensive early resuscitation measures. Crystalloids are the currently recommended fluids for management of these patients. Current studies are underway to determine the optimal end points of fluid resuscitation that determine outcome.
Department of Internal Medicine, University of Connecticut Medical Center, Farmington, CT, USA.
Guru
G
Trikudanathan
Udayakumar
U
Navaneethan
Santhi Swaroop
SS
Vege
D000208:Acute Disease; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D010195:Pancreatitis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions