Acute Pancreatitis: How Much Fluid Should We Give?

The ideal quantity of fluid resuscitation for patients with acute pancreatitis has been controversial. Two small, single-center, randomized trials showed worse outcomes with aggressive rapid fluid expansion, whereas a subsequent retrospective study revealed improved outcomes with this intervention. Recent guidelines have been vague and suggest frequent monitoring of hemodynamic status and goal-directed therapy to manage resuscitation (World J Emerg Surg 2019; 14:27; Gastroenterology 2018; 154:1096).

In this open-label, randomized trial from Spain, 249 patients with acute pancreatitis received either aggressive (20 mL/kg bolus over 2 hours, then 3 mL/kg/hour infusion) or moderate (10 mL/kg bolus only if hypovolemic, then 1.5 mL/kg/hour infusi…