Fluid therapy plays a crucial role in the management of acute pancreatitis, particularly in the early stages of the disease. The primary objectives of fluid therapy are to maintain hemodynamic stability, optimize tissue perfusion, and prevent complications such as pancreatic necrosis and multi-organ failure.
Type of fluid
- The American College of Gastroenterology (ACG) 2024 guidelines suggest the use of lactated Ringer's solution over normal saline for intravenous resuscitation in acute pancreatitis
- The World Society of Emergency Surgery (WSES) 2019 guidelines also recommend the use of isotonic crystalloids for early fluid resuscitation in patients with severe acute pancreatitis
Rate and volume of fluid administration
- The ACG 2024 guidelines suggest initiating moderately aggressive fluid resuscitation in patients with acute pancreatitis, with additional boluses administered if there is evidence of hypovolemia
- The ACG 2024 guidelines also recommend frequent reassessment of fluid volumes within 6 hours of presentation and for the next 24–48 hours, with a goal to decrease the blood urea nitrogen (BUN)
- The WSES 2019 guidelines emphasize the importance of frequent reassessment of the hemodynamic status to guide fluid administration, as fluid overload can have detrimental effects
Goal-directed therapy
- The American Gastroenterological Association (AGA) 2018 guidelines suggest the use of goal-directed therapy for fluid management in patients with acute pancreatitis
- A study found that individualized optimization of intravascular fluid status during the early course of severe acute pancreatitis led to less vascular endothelial damage, pancreatic edema, and inflammatory response compared to a treatment strategy of maximizing stroke volume by fluid loading
Special considerations
- The ACG 2024 guidelines advise caution in fluid therapy if a cardiovascular and/or renal comorbidity is present, and recommend monitoring for volume overload
- The AGA 2018 guidelines suggest avoiding the use of hydroxyethyl starch fluids in patients with acute pancreatitis
In conclusion, fluid therapy is a cornerstone of the early management of acute pancreatitis, with the type, rate, and volume of fluid administration tailored to the individual's needs and clinical status. Frequent reassessment and goal-directed therapy are key components of this approach.