Theory: The paradox of volume management in acute pancreatitis
Evidence: Prospective Randomized Controlled Trials (RCTs)
Evidence: Correlational Studies
American College of Gastroenterology (ACG) 2013 guidelines are not evidence-based
How should patients with acute pancreatitis be resuscitated?
- Although limited, all prospective RCT evidence reveals harm from large-volume resuscitation in acute pancreatitis.
- Excessive volume resuscitation increases the risk of respiratory failure, renal failure, abdominal fluid collections, sepsis, abdominal compartment syndrome, and death.
- The American Gastrointestinal Association 2013 guidelines recommend large-volume resuscitation with 250-500cc/hr crystalloid targeted to decrease the BUN. These recommendations reflect dogma rather than current evidence.
- We agree with recent evidence-based guidelines by the IAP/APA which state that most patients may be treated adequately with a resuscitation of about 2,500-4,000 ml in the first 24 hours (corresponding to roughly 125 ml/hour crystalloid infusion).
- Compared to normal saline, Lactated Ringers produces lower cytokine levels and lower rates of SIRS. Lactated ringers may be the preferred crystalloid for resuscitation of acute pancreatitis.
Image credits: https://en.wikipedia.org/wiki/Edema#/media/File:Combinpedal.jpg