Faster Discharge with Lactated Ringers than Normal Saline in First 72 H of Acute Pancreatitis: A Multicenter Randomized Trial

Authors

Peter R Farrell
Angelica W DesPain
Peter Farmer
Leslie M Farrell
Bryan Greenfield
Michael E Rogers
Lindsey Hornung
Esther Kim
Ryan Pearman
Beemnet Neway
Tyler Thompson
James E Heubi
Sona Sehgal
Rana Amoury
Maisam Abu-El-Haija

Publication Date

2-1-2024

Journal

Journal of Pediatric Gastroenterology and Nutrition

DOI

10.1002/jpn3.12082

PMID

38374568

PMCID

PMC10883603

PubMedCentral® Posted Date

2-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Humans, Acute Disease, Fluid Therapy, Pancreatitis, Patient Discharge, Ringer's Lactate, Saline Solution, Systemic Inflammatory Response Syndrome

Abstract

OBJECTIVES: Data driven strategies for acute pancreatitis (AP) in pediatrics are limited; adult data suggests lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes, but has not been studied in pediatrics. Our objective was to evaluate the efficacy of LR during the first 48 h of an AP episode compared with NS.

STUDY DESIGN: A multi-site randomized controlled clinical trial, from 2015 to 2020 (Clinical Trials.gov NCT03242473). Patients were randomized to exclusively LR or NS for the first 48 hours. Primary outcomes were C-Reactive Protein (CRP) values on admission, 24 and 48 hours. Secondary outcomes were changes in CRP and other values, time to initiation of feeds, length of stay (LOS), Systemic Inflammatory Response Syndrome (SIRS) development, and progression to severe AP (SAP).

RESULTS: We studied 76 patients (38 LR, 38 NS). CRP at 24 and 48 h were not significantly different between LR or NS group. Additionally, there were no differences in trends of BUN, amylase, lipase, SIRS status, or SAP development between the LR and NS group at 24 and 48 h. A higher proportion of LR patients (32%, 12/38) were discharged before 48 h compared to NS (13%, 5/38). The LR group had a significantly higher rate of discharge within the first 72 h compared to the NS group (p = 0.02).

CONCLUSION: The use of LR was associated with a faster rate of discharge during the intervention period and in the first 72 h, but no other differences compared to NS. This reduction in length of hospitalization has significant implications for patients and healthcare costs.