Open AccessFluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis: A triple‐blind, randomized, controlled trial
Author(s) -
deMadaria Enrique,
HerreraMarante Iván,
GonzálezCamacho Verónica,
Bonjoch Laia,
QuesadaVázquez Noé,
AlmentaSaavedra Isabel,
MirallesMaciá Cayetano,
AcevedoPiedra Nelly G,
RogerIbáñez Manuela,
SánchezMarin Claudia,
OsunaLigero Rosa,
Gracia Ángel,
Llorens Pere,
Zapater Pedro,
Singh Vikesh K,
MoreuMartín Rocío,
Closa Daniel
Publication year - 2018
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640617707864
Subject(s) - medicine , acute pancreatitis , saline , systemic inflammatory response syndrome , resuscitation , pancreatitis , anesthesia , randomized controlled trial , inflammatory response , gastroenterology , inflammation , sepsis
Background Little is known regarding the optimal type of fluid resuscitation in acute pancreatitis (AP). Objective The objective of this article was to compare the effect of lactated Ringer’s solution (LR) vs normal saline (NS) in the inflammatory response in AP. Methods We conducted a triple‐blind, randomized, controlled trial. Patients ≥ 18 admitted with AP were eligible. Patients were randomized to receive LR or NS. Primary outcome variables were number of systemic inflammatory response syndrome (SIRS) criteria at 24 hours, 48 hours and 72 hours and blood C‐reactive protein (CRP) levels at 48 hours and 72 hours. In vitro complementary experiments were performed to further explore the interaction between pH, lactate and inflammation. Results Nineteen patients receiving LR and 21 receiving NS were analyzed. The median (p25–p75) number of SIRS criteria at 48 hours were 1 (1–2) for NS vs 1 (0–1) for LR, p = 0.060. CRP levels (mg/l) were as follows: at 48 hours NS 166 (78–281) vs LR 28 (3–124), p = 0.037; at 72 hours NS 217 (59–323) vs LR 25 (3–169), p = 0.043. In vitro, LR inhibited the induction of inflammatory phenotype of macrophages and NF‐κB activation. This effect was not observed when using Ringer’s solution without lactate, suggesting a direct anti‐inflammatory effect of lactate. Conclusions Lactated Ringer’s is associated with an anti‐inflammatory effect in patients with acute pancreatitis.