Lactated Ringer's associated with better outcomes from acute pancreatitis
Patients who received only lactated Ringer's during their first 24 hours of hospitalization had about half the odds of moderately severe or severe pancreatitis as those who received only normal saline, according to a prospective international study.
For patients with acute pancreatitis, receiving lactated Ringer's solution within 24 hours of hospitalization was associated with reduced disease severity, a study found.
The prospective study included 999 patients admitted in 2015 to 2018 for acute pancreatitis at 22 hospitals in Europe, India, Latin America, and the U.S. Researchers collected data on demographics, fluid administration, and pancreatitis severity to examine the association between lactated Ringer's and pancreatitis severity outcomes. Patients' mean age was 51 years, 52% were women, and 24% developed moderately severe or severe acute pancreatitis. Results were published by the American Journal of Gastroenterology on July 20.
Thirty-three percent of patients received only lactated Ringer's, 36% received only normal saline, and 31% received a combination of fluid types. After adjustment for geographic region, etiology, body mass index, and fluid volume, the patients who received only lactated Ringer's during the first 24 hours had about half the odds of developing moderately severe or severe pancreatitis as those who received normal saline (adjusted odds ratio, 0.52; P=0.014). There was no significant difference in outcomes between the combination fluid and normal saline groups. Sensitivity analyses that controlled for admission organ failure, pancreatitis etiology, and excessive total fluid volume found similar benefits to lactated Ringer's.
The study authors concluded that use of lactated Ringer's within 24 hours of hospitalization was associated with reduced severity among patients with acute pancreatitis, hypothesizing that mechanistic benefits might relate to lactate's suppression of the potent proinflammatory inflammasome pathway and neutralization of the toxic nonesterified fatty acid through calcium.
The authors noted that the findings lend further support to several guideline recommendations and highlight a gap between guidelines on fluid choice and real-life clinical practice. They called for a large randomized clinical trial to confirm the findings, as well as additional research to explore any barriers and solutions to broader use of lactated Ringer's in acute pancreatitis.