title: Fluid resuscitation in acute pancreatitis: Normal saline or lactated Ringer's solution?
abstract: OBJECTIVE
  To investigate whether administration of Ringer's solution (RL) could have an impact on the outcome of acute pancreatitis (AP).
  
  
  METHODS
  We conducted a retrospective study on 103 patients [68 men and 35 women, mean age 51.2 years (range, 19-92 years)] hospitalized between 2011 and 2012. All patients admitted to the Department of Gastroenterology of the Central Clinical Hospital of the Ministry of Interior (Poland) with a diagnosis of AP who had disease onset within 48 h of presentation were included in this study. Based on the presence of persistent organ failure (longer than 48 h) as a criterion for the diagnosis of severe AP (SAP) and the presence of local complications [diagnosis of moderately severe AP (MSAP)], patients were classified into 3 groups: mild AP (MAP), MSAP and SAP. Data were compared between the groups in terms of severity (using the revised Atlanta criteria) and outcome. Patients were stratified into 2 groups based on the type of fluid resuscitation: the 1-RL group who underwent standard fluid resuscitation with a RL 1000 mL solution or the 2-NS group who underwent standard fluid resuscitation with 1000 mL normal saline (NS). All patients from both groups received an additional 5% glucose solution (1000-1500 mL) and a multi-electrolyte solution (500-1000 mL).
  
  
  RESULTS
  We observed 64 (62.1%) patients with MAP, 26 (25.24%) patients with MSAP and 13 (12.62%) patients with SAP. No significant difference in the distribution of AP severity between the two groups was found. In the 1-RL group, we identified 22 (55.5%) MAP, 10 (25.5%) MSAP and 8 (20.0%) SAP patients, compared with 42 (66.7%) MAP, 16 (24.4%) MSAP and 5 (7.9%) SAP cases in the 2-NS group (P = 0.187). The volumes of fluid administered during the initial 72-h period of hospitalization were similar among the patients from both the 1-RL and 2-NS groups (mean 3400 mL vs 3000 mL, respectively). No significant differences between the 1-RL and 2-NS groups were found in confirmed pancreatic necrosis [10 patients (25%) vs 12 patients (19%), respectively, P = 0.637]. There were no statistically significant differences between the 1-RL and 2-NS groups in the percentage of patients who required enteral nutrition (23 patients vs 17 patients, respectively, P = 0.534). Logistic regression analysis confirmed these findings (OR = 1.344, 95%CI: 0.595-3.035, P = 0.477). There were no significant differences between the 1-RL and 2-NS groups in mortality and the duration of hospital stay (median of 9 d for both groups, P = 0.776).
  
  
  CONCLUSIONS
  Our study failed to find any evidence that the administration of RL in the first days of AP leads to improved clinical outcomes.
authors: Michal Lipinski, Grazyna Rydzewska, Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior, 02-507 Warsaw, Poland.
authors: Michal
authors: M
authors: Lipinski
authors: Michal Lipinski, Grazyna Rydzewska, Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior, 02-507 Warsaw, Poland.
authors: Alicja
authors: A
authors: Rydzewska-Rosolowska
authors: Michal Lipinski, Grazyna Rydzewska, Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior, 02-507 Warsaw, Poland.
authors: Andrzej
authors: A
authors: Rydzewski
authors: Michal Lipinski, Grazyna Rydzewska, Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior, 02-507 Warsaw, Poland.
authors: Grazyna
authors: G
authors: Rydzewska
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010195:Pancreatitis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011044:Poland; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D012307:Risk Factors; D012720:Severity of Illness Index; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride
keywords: Acute pancreatitis; Fuid therapy; Lactated Ringer’s solution; Normal saline; Treatment