A Lee et al. Gastroenterol 2021; 160: 955-957. Lactated Ringers vs Normal Saline Resuscitation for Mild Acute Pancreatitis: A Randomized Trial

PK Garg et al. Gastroenterol 2021; 160: 655-59. Full text (editorial) Optimum Fluid Therapy in Acute Pancreatitis Needs an Alchemist

Key findings from this double-blind randomized controlled trial (n=121):

• ICU admissions were 9.8% in LR group compared with 25% of NS group (RR 0.4, CI 0.2-0.9)
• Quicker discharge with 44% at 72 hrs in LR group compared with 28% in NS group
• Median length of stay was 3.5 days (LR group) compared with 4.6 days (NS group)

Critique of study from editorial: “The strengths of their study include a well-designed protocol, reasonable sample size and inclusion of patients within 8 hours of diagnosis; thus, fluids were administered during the critical period when there is a window of opportunity to restore the intravascular volume and maintain adequate tissue perfusion. However, the study included patients with mild pancreatitis. Another issue is that the benefit shown was for secondary outcomes and, thus, these results should be taken as exploratory and hypothesis generating.”

My take: For now, lactated ringer’s is the fluid of choice in individuals with acute pancreatitis.

Related blog posts:

• LR in Pediatric Pancreatitis, NASPGHAN18 Abstract (Peter Farrell)
• Acute Pancreatitis: NASPGHAN Clinical Report.
• Acute Pancreatitis Review (2016)
• For the pediatric pancreatologists
• Pancreatitis Update (part 1) | gutsandgrowth 2017
• Pancreatitis Update (part 2) 2017
• Changing Practice Patterns with Pediatric Pancreatitis | gutsandgrowth
• Why an ERCP Study Matters to Pediatric Care | gutsandgrowth This post explains why LR may be best.