2018, Number 3
An Med Asoc Med Hosp ABC 2018; 63 (3)
Ríos ZCA, Calderón DDE, Hernández BJ
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ABSTRACTBackground: Fluid resuscitation is essential for the treatment of acute pancreatitis. Aggressive fluid resuscitation in the first 24 hours is recommended, even though several studies have shown the harms of fluid overload. Still, we lack evidence on the rate, volume and duration of optimal fluid therapy during the first 48 hours. Objective: According to the rate of fluid administration, to analyze the behavior of blood urea nitrogen level and hematocrit, mortality rate, morbidity and complications in hospitalized patients. Methods: Retrospective hospital cohort of patients with acute pancreatitis. Based on the amount of fluid administered per kilogram of weight per hour, patients were classified in tertiles: A 0-1.95 mL/kg/hour, B 1.951-3.056 mL/kg/hour and C more than 3.056 mL/kg/hour. We analyzed the outcomes among the groups in terms of mortality, prolonged in-hospital stay or critical care admission and complications. Results: Eighty-eight patients met the inclusion criteria. The average fluid administration was 4,358.85 ± 1,299.41 mL in the first 24 hours, mean: 2.48 ± 0.80 mL/kg/hour. Groups A and B presented significantly less edema than patients of group C (A versus C, p = 0.004) (B versus C, p = 0.014). Group C had greater fluid overload, pulmonary edema, longer in-hospital stay and more patients that required intensive care. Conclusion: Fluid resuscitation at a rate lower than 3.056 mL/kg hour had better clinical outcomes and a shorter in-hospital stay. A range of 1.951-3.056 mL/kg/hour is safe, with little adverse effects.