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Analysis Study Research Paper | General Surgery | India | Volume 13 Issue 3, March 2024 | Popularity: 5.1 / 10

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Role of Fluid Resuscitation in Acute Pancreatitis: A Randomised Control Trial

Dr. J. A. Jayalal, Dr. P. R. Baghavath, Dr. S. Edwin Kins Raj, Dr. Chitra P.

Abstract: Background: Pancreatitis is an inflammation of the pancreatic parenchyma, divided into acute and chronic forms. Acute pancreatitis presents with abdominal pain, a rise in serum levels of the pancreatic amylase or lipase. It is classified as mild, moderately severe, or severe AP depending on organ failure and local or systemic complications. Acute pancreatitis is a common cause of gastroenterology - related hospitalization and is linked to significant morbidity and poor outcomes. Currently, there is no reliable medication therapy for acute pancreatitis (AP), and supportive care is the mainstay of managing the condition. Early fluid resuscitation within 24 hours of the disease onset is crucial, as fluid deficiencies are a major contributor to pancreatic necrosis, SIRS, and organ failure{ 1}Aim: To study the effectiveness and safety of aggressive or controlled fluid resuscitation in acute pancreatitis. Materials and Methods: Randomized controlled study was conducted in our tertiary government institution on 50 patients admitted with the diagnosis of acute pancreatitis over four months. Patients were allotted into both groups by odd or even method and were started on aggressive or controlled fluid resuscitation therapy with lactated Ringer?s solution. Aggressive fluid resuscitation consists of a bolus of 20 ml/ kg of body weight, followed by 3 ml/kilogram/hour. Moderate fluid resuscitation consists of a bolus of 10 ml/kg in patients with hypovolemia or no bolus in patients with normal volume, followed by 1.5 ml/kilogram/hour in all patients in this group. Patients were assessed at 30 minutes, 3, 12, 24, and 72 hours, and fluid resuscitation was titrated according to the patient?s clinical status. The primary outcome of the study was the development of either moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload after randomization and during hospitalization. Results: The study found group differences in safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis. Fluid overload developed in 16% of patients who received aggressive resuscitation and in 4% of those who received moderate resuscitation. The median duration of hospitalization was 8 days in the aggressive group and 5 days in the moderate group. Conclusion: Early aggressive fluid resuscitation showed a higher incidence of fluid overload, while moderate fluid resuscitation showed decreased side effects and improved outcomes.

Keywords: Fluid therapy, acute pancreatitis, amylase, lipase

Edition: Volume 13 Issue 3, March 2024

Pages: 1471 - 1474

DOI: https://www.doi.org/10.21275/SR24321002008

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