Is a Balanced Solution Better Than Normal Saline for Acute Pancreatitis?

Several studies have suggested that a balanced solution that more closely mimics plasma (e.g., lactated Ringer's solution) might be superior to normal saline for patients with pancreatitis and other conditions that warrant substantial fluid resuscitation. The proposed mechanism is that balanced solutions cause less hyperchloremia and metabolic acidosis that can lead to renal dysfunction and stimulate the inflammatory cascade.

In a multicenter, cluster-randomized trial from China, 259 patients who were predicted to have severe acute pancreatitis (>60% patients had hypertriglyceridemia as their etiology of pancreatitis) received either balanced solution or normal saline. The primary outcome — mean serum chloride level at day 3 — was significan…