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World J Gastrointest Pharmacol Ther. May 5, 2023; 14(3): 22-32
Published online May 5, 2023. doi: 10.4292/wjgpt.v14.i3.22
Update on the strategy for intravenous fluid treatment in acute pancreatitis
Thanapon Yaowmaneerat, Apichet Sirinawasatien
Thanapon Yaowmaneerat, Nanthana-Kriangkrai Chotiwattanaphan Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai , Songkhla 90110, Thailand
Apichet Sirinawasatien, Department of Medicine, Division of Gastroenterology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand
Author contributions: Yaowmaneerat T searched the literature and drafted the manuscript; Sirinawasatien A devised the project with the main conceptual ideas and performed manuscript revisions; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have declared that no competing interests exist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Apichet Sirinawasatien, MD, Doctor, Department of Medicine, Division of Gastroenterology, Rajavithi Hospital, College of Medicine, Rangsit University, 2 Phayathai Road, Ratchathewi District, Bangkok 10400, Thailand. sui_apichet@hotmail.com
Received: February 12, 2023
Peer-review started: February 12, 2023
First decision: March 7, 2023
Revised: March 21, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 5, 2023
Processing time: 74 Days and 5.4 Hours
Abstract

Fluid therapy/resuscitation is mandatory in acute pancreatitis due to the pathophysiology of fluid loss as a consequence of the inflammatory process. For many years, without clear evidence, early and aggressive fluid resuscitation with crystalloid solutions (normal saline solution or Ringer lactate solution) was recommended. Recently, many randomized control trials and meta-analyses on fluid therapy have revealed that high fluid rate infusion is associated with increased mortality and severe adverse events compared to those resulting from moderate fluid rates, and this has triggered a paradigm shift in fluid management strategies. Meanwhile, there is evidence to show that Ringer lactate solution is superior to normal saline solutions in this context. The purpose of this review is to provide an update on the strategies for intravenous fluid treatment in acute pancreatitis, including the type, optimal amount, rate of infusion, and monitoring guides. Recommendations from recent guidelines are critically evaluated for this review in order to reach the authors' recommendations based on the available evidence.

Keywords: Acute pancreatitis; Fluid resuscitation; Aggressive fluid resuscitation; Moderate fluid resuscitation; Crystalloids; Colloids

Core Tip: The standard care for patients with acute pancreatitis is fluid therapy. According to many randomized control trials, early and non-aggressive/moderate fluid resuscitation is preferable to aggressive fluid resuscitation. An excessive amount of fluid resuscitation has been found to cause more vascular leakage, which worsens pancreatic local complications and increases infection and pulmonary complications. Ringer lactate solutions are administered as the fluid of choice in this setting to maintain adequate hemodynamic status, with a mean arterial pressure of ≥ 65 mmHg and urine output of ≥ 0.5 mL/kg/h used as the initial fluid resuscitation goal.