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Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis.
Am J Gastroenterol 2017; 112(5):797-803AJ

Abstract

OBJECTIVES

Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit. We performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis.

METHODS

Sixty patients with acute pancreatitis without systemic inflammatory response syndrome (SIRS) or organ failure were randomized within 4 h of diagnosis to aggressive (20 ml/kg bolus followed by 3 ml/kg/h) vs. standard (10 ml/kg bolus followed by 1.5 mg/kg/h) hydration with Lactated Ringer's solution. Patients were assessed at 12-h intervals. At each interval, in both groups, if hematocrit, blood urea nitrogen (BUN), or creatinine was increased, a bolus of 20 ml/kg followed by 3 ml/kg/h was given; if labs were decreased and epigastric pain was decreased (measured on 0-10 visual analog scale), hydration was then given at 1.5 ml/kg/h and clear liquid diet was started. The primary endpoint, clinical improvement within 36 h, was defined as the combination of decreased hematocrit, BUN, and creatinine; improved pain; and tolerance of oral diet.

RESULTS

The mean age of the patients was 45 years and only 14 (23%) had comorbidities. A higher proportion of patients treated with aggressive vs. standard hydration showed clinical improvement at 36 h: 70 vs. 42% (P=0.03). The rate of clinical improvement was greater with aggressive vs. standard hydration by Cox regression analysis: adjusted hazard ratio=2.32, 95% confidence interval 1.21-4.45. Persistent SIRS occurred less commonly with aggressive hydration (7.4 vs. 21.1%; adjusted odds ratio (OR)=0.12, 0.02-0.94) as did hemoconcentration (11.1 vs. 36.4%, adjusted OR=0.08, 0.01-0.49). No patients developed signs of volume overload.

CONCLUSIONS

Early aggressive intravenous hydration with Lactated Ringer's solution hastens clinical improvement in patients with mild acute pancreatitis.

Authors+Show Affiliations

Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA. VA Connecticut Healthcare System, West Haven, Connecticut, USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28266591

Citation

Buxbaum, James L., et al. "Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis." The American Journal of Gastroenterology, vol. 112, no. 5, 2017, pp. 797-803.
Buxbaum JL, Quezada M, Da B, et al. Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol. 2017;112(5):797-803.
Buxbaum, J. L., Quezada, M., Da, B., Jani, N., Lane, C., Mwengela, D., ... Laine, L. (2017). Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. The American Journal of Gastroenterology, 112(5), pp. 797-803. doi:10.1038/ajg.2017.40.
Buxbaum JL, et al. Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol. 2017;112(5):797-803. PubMed PMID: 28266591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. AU - Buxbaum,James L, AU - Quezada,Michael, AU - Da,Ben, AU - Jani,Niraj, AU - Lane,Christianne, AU - Mwengela,Didi, AU - Kelly,Thomas, AU - Jhun,Paul, AU - Dhanireddy,Kiran, AU - Laine,Loren, Y1 - 2017/03/07/ PY - 2016/09/01/received PY - 2017/01/01/accepted PY - 2017/3/8/pubmed PY - 2017/8/8/medline PY - 2017/3/8/entrez SP - 797 EP - 803 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 112 IS - 5 N2 - OBJECTIVES: Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit. We performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis. METHODS: Sixty patients with acute pancreatitis without systemic inflammatory response syndrome (SIRS) or organ failure were randomized within 4 h of diagnosis to aggressive (20 ml/kg bolus followed by 3 ml/kg/h) vs. standard (10 ml/kg bolus followed by 1.5 mg/kg/h) hydration with Lactated Ringer's solution. Patients were assessed at 12-h intervals. At each interval, in both groups, if hematocrit, blood urea nitrogen (BUN), or creatinine was increased, a bolus of 20 ml/kg followed by 3 ml/kg/h was given; if labs were decreased and epigastric pain was decreased (measured on 0-10 visual analog scale), hydration was then given at 1.5 ml/kg/h and clear liquid diet was started. The primary endpoint, clinical improvement within 36 h, was defined as the combination of decreased hematocrit, BUN, and creatinine; improved pain; and tolerance of oral diet. RESULTS: The mean age of the patients was 45 years and only 14 (23%) had comorbidities. A higher proportion of patients treated with aggressive vs. standard hydration showed clinical improvement at 36 h: 70 vs. 42% (P=0.03). The rate of clinical improvement was greater with aggressive vs. standard hydration by Cox regression analysis: adjusted hazard ratio=2.32, 95% confidence interval 1.21-4.45. Persistent SIRS occurred less commonly with aggressive hydration (7.4 vs. 21.1%; adjusted odds ratio (OR)=0.12, 0.02-0.94) as did hemoconcentration (11.1 vs. 36.4%, adjusted OR=0.08, 0.01-0.49). No patients developed signs of volume overload. CONCLUSIONS: Early aggressive intravenous hydration with Lactated Ringer's solution hastens clinical improvement in patients with mild acute pancreatitis. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/28266591/Early_Aggressive_Hydration_Hastens_Clinical_Improvement_in_Mild_Acute_Pancreatitis_ L2 - http://Insights.ovid.com/pubmed?pmid=28266591 DB - PRIME DP - Unbound Medicine ER -