Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit.
Dr James Buxbaum and colleagues from California, USA performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis.
The team randomized 60 patients with acute pancreatitis without systemic inflammatory response syndrome or organ failure within 4 hours of diagnosis to aggressive vs. standard hydration with Lactated Ringer’s solution.
Patients were assessed at 12-hour intervals.
|23% had comorbidities|
|American Journal of Gastroenterology|
At each interval, in both groups, if hematocrit, blood urea nitrogen, or creatinine was increased, a bolus of 20 ml/kg followed by 3 ml/kg/hour was given; if labs were decreased and epigastric pain was decreased, hydration was then given at 1.5 ml/kg/hour and clear liquid diet was started.
The team's primary endpoint, clinical improvement within 36 hours, 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 23% had comorbidities.
The researchers found that a higher proportion of patients treated with aggressive vs. standard hydration showed clinical improvement at 36 hours.
The team observed that the rate of clinical improvement was greater with aggressive vs. standard hydration by Cox regression analysis.
The researchers noted that persistent systemic inflammatory response syndrome occurred less commonly with aggressive hydration as did hemoconcentration.
No patients developed signs of volume overload.
Dr Buxbaum's team concludes, "Early aggressive intravenous hydration with Lactated Ringer’s solution hastens clinical improvement in patients with mild acute pancreatitis."