Update on the strategy for intravenous fluid treatment in acute pancreatitis

Table 3 Authors’ recommendations for fluid resuscitation strategy in acute pancreatitis

Parameter	Recommendation
Who	All patients with any severity
Timing	Early fluid resuscitation is better
Type of fluid	Ringer lactate solutions better than normal saline solutions
	Avoid synthetic colloids (HES or Dextran), Limited data in human albumin
Amount of fluid
Mild pancreatitis	3 L in 24 h and 4-6 L in 48 h
Moderate or severe pancreatitis	3-4 L in 24 h and 6-8 L in 48 h based on clinical/lab parameters
Rate of infusion
Mild pancreatitis	1.5 mL/kg/h with bolus dose 10 mL/kg/h in 1-2 h in patients with hypovolemia, BUN > 25, Hematocrit ≥ 44%, AKI, Age < 40 yr, and Alcoholic etiology
Moderate or severe pancreatitis	1.5-3 mL/kg/h with bolus dose 10-20 mL/kg/h in 1-2 hours or higher in hypotension
Monitoring goals	MAP ≥ 65 mmHg, Urine output ≥ 0.5 mL/kg/h
	Hematocrit < 44% and/or BUN < 25 mg/dL at 12 and 24 h (for guided fluid rate adjustment)
	Invasive monitoring and dynamic parameters needed in ICU patients or cardio/renal dysfunction patients
Duration	24-48 h, Infusion can stop after 24 h if oral feeding can be tolerated in mild pancreatitis

HES: Hydroxyethyl starch; BUN: Blood urea nitrogen; AKI: Acute kidney injury; MAP: Mean arterial pressure.