Elsevier

Pancreatology

Volume 2, Issue 2, 2002, Pages 104-107
Pancreatology

Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis?

https://doi.org/10.1159/000055899Get rights and content

Abstract

Background/Aims: In previous studies, we have demonstrated that hemoconcentration was an early marker for necrotizing pancreatitis. The aim of the present study was to determine whether fluid resuscitation could prevent pancreatic necrosis among patients with hemoconcen-tration at the time of admission. Methods: Data was pooled from the prior two studies of all patients with necrotizing pancreatitis and interstitial pancreatitis with a hematocrit of ≥44 on admission. Hematocrit values in necrotizing pancreatitis and interstitial pancreatitis were compared at admission and at 24 h. Statistical analyses were performed using the Wilcoxon rank-sum test. Results: A total of 39 patients satisfied our inclusion criteria, 28 with necrotizing pancreatitis and 11 with interstitial pancreatitis. Patients with necrotizing pancreatitis presented earlier than patients with interstitial pancreatitis (median 18 vs. 38 h, respectively) (p = 0.005). There was no significant difference between the intergroup median hematocrits on admission and at 24 h. All patients with hematocrits that failed to decrease at 24 h developed necrotizing pancreatitis (12/28 with necrotizing pancreatitis vs. 0/11 with interstitial pancreatitis) (p = 0.009). There was no significant difference at 24 h in rehydration among the three groups: 4.0 liters among the 12 patients with necrotizing pancreatitis whose hematocrits increased and 4.5 liters among the 16 whose hematocrits decreased at 24 h, and 4.1 liters among the 11 patients with interstitial pancreatitis (p = 0.81). Conclusion: Patients who presented early were more likely to have necrotizing pancreatitis than interstitial pancreatitis. While fluid resuscitation was not shown to prevent pancreatic necrosis, all patients with inadequate fluid resuscitation as evidenced by persistence of hemoconcentration at 24 h developed necrotizing pancreatitis.

References (14)

There are more references available in the full text version of this article.

Cited by (140)

  • The Impact of an Inpatient Pancreatitis Service and Educational Intervention Program on the Outcome of Acute Pancreatitis

    2022, American Journal of Medicine
    Citation Excerpt :

    Buxbaum et al7 demonstrated that length of stay decreased when fluid resuscitation was closely monitored with clear clinical parameters in place. The service provided standardized, evidence-based recommendations for goal-directed fluid resuscitation monitoring urine output, renal function, and hematocrit.23-25 Furthermore, the decision-support tool also outlined clinical reassessment to bolster evidence-based practice, enabling providers, regardless of experience, to manage mild acute pancreatitis.

  • Emergency and critical care medicine of pancreatic diseases

    2020, Integrative Pancreatic Intervention Therapy: A Holistic Approach
  • Acute Pancreatitis: Updates for Emergency Clinicians

    2018, Journal of Emergency Medicine
    Citation Excerpt :

    Release of inflammatory mediators also contributes to increased vascular permeability and third spacing of fluid (19). Inadequate fluid resuscitation after 24 h of hospital care has been associated with increased rates of pancreatic necrosis (84). Consequently, large volume fluid resuscitation is often performed in these patients.

  • Recent Treatment Strategies for Acute Pancreatitis

    2024, Journal of Clinical Medicine
View all citing articles on Scopus
1

Peter A. Banks, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (USA), Tel. +1 617 732 6747, Fax +1 617 566 0338

View full text