Ms. Thuy Dam
Clinical question: Does the administration of lactated ringers (LR) in the first 24 hours of admission reduce the risk of more severe forms of acute pancreatitis compared to normal saline?
Background: Current guidelines for the initial management of acute pancreatitis include fluid resuscitation, though the optimal fluid solution has not yet been established. This study primarily focused on generating more evidence to determine an association between the type of intravenous (IV) fluids and clinical outcomes of moderately severe to severe cases of acute pancreatitis.
Study design: Retrospective, observational, cohort study
Setting: The patients from the APPRENTICE, an international multisite prospective study across four geographic regions of the world, conducted between August 2015 and January 2018 across 22 centers, were utilized for this study cohort. The data was managed at the University of Pittsburgh Medical Center.
Synopsis: Data from 999 adult patients (18+ years old) who were directly admitted for acute pancreatitis within seven days of abdominal pain onset were analyzed for this study. Patients with chronic pancreatitis, pancreatic cancer, or any kind of cancer requiring chemotherapy or organ transplantation were excluded. Using a mixed-effects logistic regression model, patients receiving LR fluids compared to normal saline had a 48.2% decrease in their likelihood (aOR of 0.518) of developing moderately severe or severe acute pancreatitis. Secondary mixed-effects logistic regression models were used to exclude cases with organ failure within the first hour of admission to account for baseline severity, post-endoscopic retrograde cholangiopancreatography etiology, and aggressive fluid resuscitation greater than 4 L in 24 hours. Blood urea nitrogen and systemic inflammatory response syndrome were both found to be statistically significant in association with the development of moderately severe to severe pancreatitis. LR use varies widely across the world as there are currently no emergency medicine society-driven guidelines for the management of acute pancreatitis, compared to an already established gastrointestinal society recommendation.
Bottom line: LR usage, compared to normal saline, in the first 24 hours was associated with better outcomes for moderately severe to severe acute pancreatitis.
Citation: Lee PJ, Culp S, et al. Lactated Ringers use in the first 24 hours of hospitalization is associated with improved outcomes in 999 patients with acute pancreatitis. Am J Gastroenterol. 2023;118(12):2258-66.
Ms. Thuy Dam is a hospital medicine physician assistant at Stanford Health Care in Palo Alto, Calif., and a faculty member at Stanford’s School of Medicine in Stanford, Calif.