I just listened to a great lecture at Dartmouth-Hitchcock Medical Center. Dr. TJ Lydon spoke about pancreatititis. He talked about how to decrease morbidity and mortality. He believes that fluid management and even choice of fluids can significantly effect outcomes and even mortality. He recommends using LR instead of NS. Initially, one should start with 20cc/kg and then 3cc/kg/hr for the next 8 hours and then recheck BUN. Changes in BUN have been linked to mortality
With regard to LR. He referred to this article
Clin Gastroenterol Hepatol. 2011 Aug;9(8):710-717.e1. doi: 10.1016/j.cgh.2011.04.026. Epub 2011 May 12.Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis.Wu BU1, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, Smith B, Banks PA, Conwell DL.
BACKGROUND & AIMS:Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. We performed a randomized controlled trial to evaluate the impact of a goal-directed fluid resuscitation protocol on systemic inflammation in patients with acute pancreatitis. We then determined the impact of resuscitation with lactated Ringer’s solution, compared with normal saline.
METHODS:We performed a randomized controlled trial of 40 patients with acute pancreatitis at 3 New England hospitals from May 2009-February 2010. Patients received goal-directed fluid resuscitation with lactated Ringer’s solution, goal-directed fluid resuscitation with normal saline, standard fluid resuscitation with lactated Ringer’s solution, or standard fluid resuscitation with normal saline. Systemic inflammation was measured on the basis of levels of systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) level after 24 hours.
RESULTS:The volumes of fluid administered during a 24-hour period were similar among patients given goal-directed or standard fluid resuscitation (mean, 4300 vs 4600 mL, respectively; P = .87). Goal-directed resuscitation did not significantly reduce incidence of SIRS, compared with standard resuscitation (11.8% vs 13.0%, respectively; P = .85) or levels of CRP after 24 hours (87.1 vs 69.2 mg/dL, respectively; P = .75). By contrast, there was a significant reduction in SIRS after 24 hours among subjects resuscitated with lactated Ringer’s solution, compared with normal saline (84% reduction vs 0%, respectively; P = .035); administration of lactated Ringer’s solution also reduced levels of CRP, compared with normal saline (51.5 vs 104 mg/dL, respectively; P = .02).
CONCLUSIONS:Patients with acute pancreatitis who were resuscitated with lactated Ringer’s solution had reduced systemic inflammation compared with those who received saline.