Hydration with Lactated Ringer’s (LR) solution appeared to better reduce the need for intensive care and shorten the length of hospitalization for patients with acute pancreatitis vs Normal Saline, according to findings from a study published in Gastroenterology.
Acute pancreatitis is a leading cause of hospitalization in the United States and early, aggressive intravenous hydration has been the mainstay of treatment. Although clinical practice guidelines and experts agree on the fluid volume that should be used, the optimal fluid type remains to be determined. Thus, the researchers performed a double-blinded randomized controlled trial to compare the efficacy of LR solution vs Normal Saline (NS) for acute pancreatitis resuscitation in 121 patients who presented to a Los Angeles County Hospital between September 2018 and August 2019.
At the time of enrollment, 17 patients (27.9%) in the LR arm and 14 patients (23.3%) in the NS arm had systemic inflammatory response syndrome (SIRS). The investigators used a last observation carried forward approach to analyze SIRS prevalence because patients managed with LR were discharged earlier. For example, 44% of patients in the LR group were discharged at 72 hours vs 28.3% of patients in the NS group.
The researchers found that there was no difference in SIRS prevalence at 24 hours for LR vs NS. This remained true at the 48- and 72-hour end points. In addition, intensive care unit (ICU) admissions occurred less frequently in patients randomly assigned to receive LR (9.8%) compared with those assigned to receive NS (25.0%). The median length of hospitalization was also determined to be shorter in the LR group compared with the NS group (3.5 vs 4.6 days, respectively; P =.049).
Additionally, hyperchloremia developed less frequently at 24 hours in the LR group. Local complications occurred in 6.6% and 15% of patients assigned to LR vs NS, respectively. There was no difference in organ failure or recurrent pancreatitis between the groups, and importantly, no mortality.
“This [study] provides the strongest evidence thus far to favor LR for the resuscitation of patients with acute pancreatitis,” the investigators concluded. “Though we did not detect a difference in the prevalence of [SIRS], we demonstrated that LR decreased ICU admission and shortened length of hospitalization. The effect was robust across pancreatitis etiologies and patient demographics.”
Lee A, Ko C, Buitrago C, Hiramoto B, Hilson L, Buxbaum J; NS-LR Study Group. Lactated ringers vs. normal saline resuscitation for mild acute pancreatitis: a randomized trial. Gastroenterology. Published online November 4, 2020. doi: 10.1053/j.gastro.2020.10.044