Fluid resuscitation in acute pancreatitis

Abstract

Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients. The basic goal of fluid epletion should be to prevent or minimize the systemic response to inflammatory markers. For this review, various studies and reviews were critically evaluated, along with authors’ recommendations, for predicted severe or severe pancreatitis based on the available evidence.

Keywords: Acute pancreatitis, Fluid resuscitation, Aggressive fluid therapy, Crystalloids, Colloids

Core tip: Acute pancreatitis can manifest as a severe form, which has a high mortality rate. The treatment of AP is primarily supportive, and fluid replacement therapy has emerged as one of the key treatment strategies. There is a lack of randomized studies addressing the questions of the best type of fluid, amount of fluid and rate of fluid transfusion. This paper reviews the available literature and the controversies and attempts to frame guidelines for fluid therapy in acute pancreatitis.