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Am J Gastroenterol. 2017 May;112(5):797-803. doi: 10.1038/ajg.2017.40. Epub 2017 Mar 7.

Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis.

Author information

1
Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
2
Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
3
Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
4
Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
5
Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA.
6
VA Connecticut Healthcare System, West Haven, Connecticut, USA.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

Early aggressive intravenous hydration with Lactated Ringer's solution hastens clinical improvement in patients with mild acute pancreatitis.

Comment in

PMID:
28266591
DOI:
10.1038/ajg.2017.40
[Indexed for MEDLINE]

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