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Saturday, October 22, 2022

IV Fluid in Pancreatitis

REBEL EM - By Anand Swaminathan - September 29, 2022
Article: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). NEJM 2022. PMID: 36103415
Clinical Question: Does the use of moderate fluid resuscitation in acute pancreatitis decrease the rate of progression to moderate/severe pancreatitis in comparison to aggressive fluid resuscitation?
Authors Conclusions: “In this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes.”
Our Conclusions: We agree with the authors. Aggressive fluid administration results in an increased likelihood of fluid overload. Though not statistically significant, the primary outcome as well as many of the important secondary outcomes favor the moderate fluid group as well.
Potential to Impact Current Practice: The tide has been turning against the use of aggressive fluid resuscitation in acute pancreatitis and this high-quality study should increase the push for a paradigm change. Administer smaller fluid boluses (10 cc/kg) in patients with hypovolemia (and no bolus in those with normovolemia) and start maintenance fluids at 1.5 cc/kg/hour.