title: Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis.
abstract: Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit. We performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis.
  
  
  
  Sixty patients with acute pancreatitis without systemic inflammatory response syndrome (SIRS) or organ failure were randomized within 4 h of diagnosis to aggressive (20 ml/kg bolus followed by 3 ml/kg/h) vs. standard (10 ml/kg bolus followed by 1.5 mg/kg/h) hydration with Lactated Ringer's solution. Patients were assessed at 12-h intervals. At each interval, in both groups, if hematocrit, blood urea nitrogen (BUN), or creatinine was increased, a bolus of 20 ml/kg followed by 3 ml/kg/h was given; if labs were decreased and epigastric pain was decreased (measured on 0-10 visual analog scale), hydration was then given at 1.5 ml/kg/h and clear liquid diet was started. The primary endpoint, clinical improvement within 36 h, was defined as the combination of decreased hematocrit, BUN, and creatinine; improved pain; and tolerance of oral diet.
  
  
  
  The mean age of the patients was 45 years and only 14 (23%) had comorbidities. A higher proportion of patients treated with aggressive vs. standard hydration showed clinical improvement at 36 h: 70 vs. 42% (P=0.03). The rate of clinical improvement was greater with aggressive vs. standard hydration by Cox regression analysis: adjusted hazard ratio=2.32, 95% confidence interval 1.21-4.45. Persistent SIRS occurred less commonly with aggressive hydration (7.4 vs. 21.1%; adjusted odds ratio (OR)=0.12, 0.02-0.94) as did hemoconcentration (11.1 vs. 36.4%, adjusted OR=0.08, 0.01-0.49). No patients developed signs of volume overload.
  
  
  
  Early aggressive intravenous hydration with Lactated Ringer's solution hastens clinical improvement in patients with mild acute pancreatitis.
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Buxbaum
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Quezada
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Da
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Niraj
authors.initials: N
authors.lastname: Jani
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Christianne
authors.initials: C
authors.lastname: Lane
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Didi
authors.initials: D
authors.lastname: Mwengela
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kelly
authors.affiliation: Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Jhun
authors.affiliation: Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Dhanireddy
authors.affiliation: Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA.|VA Connecticut Healthcare System, West Haven, Connecticut, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006400:Hematocrit; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010195:Pancreatitis / Q000097:blood / Q000150:complications / Q000628:therapy*; D000077325:Ringer's Lactate; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D003404:Creatinine