title: A comparative analysis of nasogastric and intravenous fluid resuscitation in patients with malignant obstructive jaundice prior to endoscopic biliary drainage.
abstract: BACKGROUND
  An alternative to intravenous is nasogastric fluid administration through normal functioning gut. Though not common, this practice has significance in mass causalities and elective situations.
  
  
  OBJECTIVE
  The study was designed to compare nasogastric and intravenous fluid resuscitation in malignant obstructive jaundice (OJ) and their effect on endotoxemia.
  
  
  METHODS
  Sixty patients with malignant OJ undergoing endoscopic biliary drainage were randomized into two groups. A total of 4 l of fluid (Ringer's lactate) was administered to Group A through nasogastric tube and to Group B through intravenous route for 48 h. Vital parameters, serum bilirubin, serum creatinine, creatinine clearance rate, electrolytes, and endotoxemia were monitored.
  
  
  RESULTS
  Significant improvement in blood pressure (Group A, P = 0.014; Group B, P = 0.020) and significant decrease in serum bilirubin level (Group A, P = 0.001; Group B, P > 0.0001) was observed in both groups after resuscitation. Significantly decreased (P = 0.036) post hydration endotoxin level was observed in Group A as compared to Group B. Febrile events were significantly higher (P = 0.023) in Group B as compared to Group A (6 vs 0). Electrolyte abnormalities were found more in Group B, however statistically insignificant.
  
  
  CONCLUSIONS
  In OJ patient undergoing biliary drainage, preoperative fluid resuscitation through nasogastric tube may be helpful in reducing postoperative septic complications and endotoxemia.
authors.affiliation: Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India.
authors.forename: Kavita
authors.initials: K
authors.lastname: Baghel
authors.forename: Saloni
authors.initials: S
authors.lastname: Raj
authors.forename: Induja
authors.initials: I
authors.lastname: Awasthi
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.forename: Abhijit
authors.initials: A
authors.lastname: Chandra
authors.forename: Rajeshwar Nath
authors.initials: RN
authors.lastname: Srivastava
keywords: Endotoxemia; Fluid therapy; Obstructive jaundice; Parenteral infusion; Resuscitation