Assessment of the outcome in patients with acute pancreatitis receiving normal volume fluid therapy and high volume fluid therapy in the initial 24 hours
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 9, Pages 3690-3695
AbstractAim: This study aims at analyzing the persistence or occurrence of SIRS and organ failure in patients with acute pancreatitis receiving normal volume fluid therapy and high volume fluid therapy in the initial 24 hours.
Material and methods: The study was a prospective observational study conducted in the Department of General Surgery, Vardhman Mahavir Medical College and safdarjung Hospital, New Delhi, India for 18 months. 120 Patients with AP were included in this study. Systemic inflammatory response syndrome (SIRS) score and modified Marshalls score were accessed at admission. Patients are assessed at 24 and 48 hours for the persistence or worsening of SIRS, organ failure and local complications.
Results: The study population consisted of 75 males (62.5%) and 45 females (37.5%). The etiology of acute pancreatitis was most commonly alcohol (n=61; 50.83%) and gallstone (n=45; 37.5%) related. Other 14 cases were due to drugs and post endoscopic retrograde cholangiopancreatography (ERCP). Most of the patients 63(52.5%) presented after 24 hours from the onset of symptoms. In the normal volume group the mean amount of fluid given in initial 24 hours was 2512±269.88 ml and the mean rate of fluid administration was 106.845±11.04 ml/hour. In the high volume group the mean amount of fluid given in initial 24 hours was 5832±895.87 ml and the mean rate of fluid administration was 262.22±40.11 ml/hour. Persistence/worsening of SIRS at 48 hours were more in normal volume fluid group compared to the high volume fluid group (p=0.081). Organ failure at 48 hours is more in normal volume fluid group compared to the high volume fluid group (p=0.079). Incidence of local complications was equal in both groups. In normal volume group with organ failure the system involved was renal system in one and respiratory system in the other. In high volume group the organ system involved was renal system. At the time of presentation, in the normal volume group 12 patients had SIRS and 2 patient had organ failure. At the end of 48 hours 7 patients had SIRS, 3 patients had organ failure and 2 patient developed local complication in the form of acute fluid collection. In organ failure the system involved was renal system in one and respiratory system in the other. In the high volume group 24 patients had SIRS and 5 patients had organ failure at the time of admission. After 48 hours 6 patients had SIRS, 2 had organ failure and 2 developed pancreatic ascites.
Conclusion: we concluded that there was not found any statistically significant difference in the clinical outcomes of AP patients receiving normal or high volume fluid resuscitation in the initial 24 hours.
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