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Impact of Intravenous Fluid Therapy in Predicted Severe Acute Pancreatitis: Post-Hoc Analysis in a Prospective Multicenter Cohort

Anita van Eck van der Sluijs, Janneke van Grinsven, Alferso C Abrahams, Cherèl Brem, Olaf J Bakker, Willem Jan W Bos, Hjalmar C van Santvoort, Marco J Bruno, Harry van Goor, Sandra van Brunschot, Marc G Besselink, Maarten B Rookmaaker for the Dutch Pancreatitis Study Group

Objective Intravenous fluid therapy is the cornerstone in early treatment of acute pancreatitis. Guidelines recommend a balanced salt solution to obtain a urinary output >0.5 ml/kg/h. However, the clinical practice of intravenous fluid therapy is largely unknown. Methods A post-hoc analysis was performed in a prospective multicenter cohort from 19 centers (August 2008 - June 2012) with predicted severe acute pancreatitis. The urinary output, plasma sodium, potassium, acid-base status, inflammation parameters and need for correction of biochemical abnormalities were evaluated. Results Among 205 included patients, the majority (n=144 (70%)) received normal saline, restricting our analysis to the impact of normal saline infusion. Patients received a median volume of 3000, 3200 and 3000 ml saline at day 1, 2 and 3 of admission, whereas 20 (14%), 18 (12%) and 9 (6%) patients had an insufficient diuresis (≤0.5 ml/kg/h) during those days. Diuretics were given to 68 patients (47%). Patients receiving normal saline had a significant decrease in pH after 48 hours (median from 7.43 to 7.28), acidosis developed in 12 patients (8%) and potassium supplementation was given to 97 patients (67%). Conclusions The current use of normal saline in patients with predicted severe acute pancreatitis is associated with low urine output, need for diuretics and frequent biochemical abnormalities, necessitating correction. Future studies should assess to what extent optimized fluid therapy can improve outcomes.