73 Measuring Clinical Response to Lactated Ringer's vs. Normal Saline in Acute Pancreatitis: A Retrospective Study at a Community Hospital

Abstract

INTRODUCTION: Acute pancreatitis is the most common GI cause of U.S. hospital admissions, and the incidence is rising.1,2 Aggressive IV fluid resuscitation and pain control are the mainstay of therapy; with the therapeutic goal to resume diet as soon as safely possible, especially within the first 48–72 hours.3–6 Several studies and guidelines have suggested LR may provide anti-inflammatory benefits as measured by CRP and SIRS criteria.6–8 Despite an improvement in SIRS criteria, studies have shown no mortality benefit.9 The primary goal of this study was to compare NS vs LR with improved clinical response as the primary endpoint. Clinical response was measured by time to diet initiation upon ED presentation. Secondary goals examined if the timing to initiation of IV fluids led to improved clinical outcome regardless of fluid type, as this has not been examined in previous studies. METHODS: Data was abstracted for all adult patients 18 years of age or older with an admitting diagnosis of acute pancreatitis from 1/1/17–12/31/17. Primary fluid type was determined by reviewing medication and IV infusion orders and was calculated by length of time for which the fluid was administered. A subgroup analysis was performed comparing patients within groups based on their BISAP score (0–1, 2, >3). Time to initiation of diet was examined by calculating the difference from time of arrival to the ED to the time that diet was ordered. For the secondary endpoint, patients were compared based on timing of initial fluid administration (<2 hours from arrival versus >4 hours form arrival). To determine if there was a significant difference when comparing time to diet initiation, a student's t-test was utilized. RESULTS: Complete data was collected on 200 patients. NS was the primary fluid type in 77% and LR for 21.5%. Time to diet initiation was shorter for patients receiving NS in all subgroups. This finding was significant in patients with a BISAP score of 1 or below (Table 2). The data indicates that when fluids were initiated within two hours as compared to greater than four hours, diet was initiated 7.4 hours sooner (Table 3). Diet initiation was delayed in patients with a BISAP of 3 or greater in both the NS and LR group. CONCLUSION: Our study did not demonstrate any clinical difference in disease and symptomatic resolution based on fluid type. Time to fluid initiation may be more important than fluid choice. This should be studied further with larger populations.