Angsubhakorn A.1, Tipchaichatt K.1, Chirapongsatorn S.1

1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand

Background/Aims: Controversy remains regarding fluid management strategy, optimal volume and rate of intravenous fluid in mild acute pancreatitis. We performed a randomized controlled trial to compare clinical improvement and inflammatory markers between aggressive and standard fluid management.

Methods: A single center prospective randomized controlled trial was conducted in a tertiary care hospital. We randomized patients with a diagnosis of mild acute pancreatitis using revised Atlanta classification in two groups, the aggressive (20 ml/kg bolus followed by 3 ml/kg/h) and standard (10 ml/kg bolus followed by 1.5 ml/kg/h) intravenous hydration with Lactated Ringer’s solution. Primary outcome was clinical improvement at 24 and 36 hours.

Results: The mean age of patients was 46 years and 34 patients (77%) were male. The average volumes of fluid during the first 24 hours in aggressive and standard groups was 4,886 ml (71 ml/kg) and 3,985 ml (53 ml/kg), respectively; p-value 0.002.

Aggressive intravenous hydration did not significantly improve clinical outcome compared with standard intravenous hydration (45.45% vs. 31.82%, respectively; p-value 0.353). However, subgroup analysis between patients with obese and non-obese status, revealed aggressive intravenous hydration significantly improved clinical outcome within the first 24 hours in obese group (Table 3).

Conclusion: Aggressive intravenous hydration with Lactated Ringer’s solution did not improve clinical outcome in mild acute pancreatitis but showed statistically significant improvement only in patients with obese status.

Keywords: acute pancreatitis, aggressive intravenous hydration, obese, Lactated Ringer