TY - JOUR
T1 - Fluid resuscitation with lactated Ringer’s solution vs normal saline in acute pancreatitis
T2 - A triple-blind, randomized, controlled trial
AU - de-Madaria, Enrique
AU - Herrera-Marante, Iván
AU - González-Camacho, Verónica
AU - Bonjoch, Laia
AU - Quesada-Vázquez, Noé
AU - Almenta-Saavedra, Isabel
AU - Miralles-Maciá, Cayetano
AU - Acevedo-Piedra, Nelly G.
AU - Roger-Ibáñez, Manuela
AU - Sánchez-Marin, Claudia
AU - Osuna-Ligero, Rosa
AU - Gracia, Ángel
AU - Llorens, Pere
AU - Zapater, Pedro
AU - Singh, Vikesh K.
AU - Moreu-Martín, Rocío
AU - Closa, Daniel
N1 - Funding Information:
The RCT was funded by AIGPA, an association of researchers in gastroenterology from the province of Alicante, Spain. In vitro experiments were supported by a national Spanish public grant, project FIS PI13/00019 from Instituto de Salud Carlos III; L.B. is supported by a predoctoral fellowship from Generalitat de Catalunya (AGAUR, FI DGR 2013).
Publisher Copyright:
© 2017, © Author(s) 2017.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - 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.
AB - 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.
KW - Acute pancreatitis
KW - fluid resuscitation
KW - lactated Ringer’s solution
KW - randomized controlled trial
KW - systemic inflammatory response syndrome/prevention and control
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U2 - 10.1177/2050640617707864
DO - 10.1177/2050640617707864
M3 - Article
C2 - 29435315
AN - SCOPUS:85041122603
SN - 2050-6406
VL - 6
SP - 63
EP - 72
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 1
ER -