IVF in acute pancreatitis

Q: Which of the following intravenous fluid (IVF) preferred in acute pancreatitis?

A) Normal Saline (NS)
B) Lactate Ringer's (LR)


Answer: B

The three pillars of management of acute pancreatitis are

• fluid resuscitation 
• pain control
• nutritional support 

IVF take precedence over everything as it has clearly shown that early and proper (considering renal failure and congestive heart failure) IVF resuscitation decreases analgesic requirement, increases enteral tolerance and decreases morbidity and mortality.

Although evidence is not very strong it favors LR as a preferred agent if there is no renal insuff., hypercalcemia or hyperkalemia. LR has shown to lower mean C-reactive protein (CRP) level and reduction in systemic inflammatory response syndrome (SIRS).

#gastroenterelogy
#resuscitation
#hemodynamic


References:

1. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13:e1. 

 2. Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 2011; 9:710. 

3. Trikudanathan G, Navaneethan U, Vege SS. Current controversies in fluid resuscitation in acute pancreatitis: a systematic review. Pancreas 2012; 41:827. 

4. Gardner TB, Vege SS, Chari ST, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 2009; 9:770.