Early Aggressive Hydration Is Associated with Less Narcotic Use in Mild Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis is among the leading causes of hospitalization due to gastrointestinal disease in the United States and accounts for 2.6 billion dollars annually in medical costs. No pharmacologic agents have been shown to impact the course of acute pancreatitis except early aggressive hydration which was studied in recent randomized clinical trial for mild acute pancreatitis. Our aim was to determine if aggressive hydration has been followed for mild acute pancreatitis and difference in outcomes for standard versus aggressive hydration patients. Methods: Acute Pancreatitis patients were identified with ICD-10 codes. Patients with Sepsis, SIRS, heart failure, ascites, gastrointestinal bleeding,pancreatic necrosis and abscess, pulmonary edema, peripheral edema, cirrhosis, low blood pressure, kidney dysfunction and hyponatremia were excluded with ICD-10 codes, initial vitals and laboratory values. A total of 531 subjects who met the inclusion and exclusion criteria for mild acute pancreatitis were included retrospectively in the analysis. The subjects were classified into three groups based on the amount of hydration the received in the first 12 hours of admission: Hydration Group A (0-1.5 ml/kg/hr), Hydration Group B (>1.5-3 ml/kg/hr), and Hydration Group C (>3 ml/kg/hr). Length of stay (LOS) and narcotic use on the last day among the three groups were analyzed using Chi-square test. A p-value of less than 0.05 was considered statistically significant. All data analyses were conducted using IBM SPSS Statistics 24. Results: Patients with aggressive hydration (>3 ml/kg/hr) had a greater reduction in creatinine (mean difference = -0.05, p= 0.017) compared to those who received standard hydration (0-1.5 ml/kg/hr) (Table 1). There was no significant difference in LOS among the three hydration groups, p>0.05 (Table 2).Patients with aggressive hydration (>3 ml/kg/hr) were less likely to use narcotics on the last day of hospitalization (23.9% vs. 35.3%, p=0.044) compared to standard hydration (0-1.5 ml/kg/hr) (Table 3). Conclusion: Early aggressive fluid resuscitation for mild acute pancreatitis associated with decreased recovery time. Narcotic use in last twenty-four hours of hospitalization was significantly less in aggressive hydration group. Use of less narcotics among the aggressive hydration group for pancreatitis patients should be further investigated in randomized trials.67 Figure 1. Difference in Creatinine in first and second day of admission among hydration groups Table 2: Length of Stay (LOS) comparison among intravenous hydration groups Table 3: Narcotic use on last day of admission among intravenous hydration groups