The effect of type of fluid on disease severity in acute pancreatitis treatment

S. Kayhan, B. Selcan Akyol, M. Ergul, C. Baysan

Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. drkayhansanem@yahoo.com

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• Gastroenterology

OBJECTIVE: In this study, we aimed to investigate the effect of type of fluid (Normal Saline solution: NSS or Lactated Ringer’s solution: LRS) to be selected in fluid replacement in acute pancreatitis (AP) treatment on disease severity.

SUBJECTS AND METHODS: This study is a prospective, single-center study. Patients diagnosed with acute pancreatitis in emergency service were included in the study and randomized to receive LRS or NSS. The severity of AP was determined regarding Revised Atlanta Classification. C-reactive protein (CRP) levels and serum pH and bicarbonate (HCO3) levels were measured to evaluate the systemic inflammatory response and to detect changes in acid-base balance, respectively.

RESULTS: Sixty-five and seventy-seven patients receiving NSS and LRS, respectively, were analyzed. Eighty-nine (67.4%) and 43 (32.6%) patients were with mild and moderate AP, respectively; however, there was no patient with severe AP. The frequency of moderate AP was significantly lower in the LRS group than the NSS group in terms of the severity of AP (p=0.011). Subjects that were randomized to receive LRS had lower CRP levels when compared to the participants in the NSS treatment arm 48 hours after resuscitation (p=0.010). In addition to these results, serum pH and HCO3 level in patients resuscitated with NSS reduced in comparison to LRS (p<0.001).

CONCLUSIONS: Resuscitation with LRS is associated with decreased severity of AP in patients with AP. It may derive from how it causes lower CRP levels.

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