Fluid Therapy in Acute Pancreatitis-Current Knowledge and Future Perspectives

Acute pancreatitis (AP) is one of the most frequent diseases requiring hospitalization in gastroenterology or intensive care unit departments. Its incidence and hospitalization rates have steadily increased over the last few years, contributing to high costs of medical care. This disease is associated with relevant mortality and morbidity rates. Fluid therapy in the first 48-72 h has an important role in the clinical course and complications; however, it has been raising numerous controversies recently. We present a review article summarizing the current knowledge about fluid therapy in AP. The demonstrated results are based on the most recent clinical studies published in the last five years. Data confirms that the therapy should be individualized along with the amount of fluids adapted to body mass, concomitant diseases, critical signs, and laboratory markers. A relevant issue in the context of fluid therapy of AP is fluid resuscitation that should be implemented in some patients upon hospital admission to maintain organ perfusion and substrate delivery. Ringer's lactate should be preferred in the vast majority of AP cases over normal saline solution. Its use is associated with lowered risk of intensive care unit admission and local complications development, reduced hospital stay, and decreased mortality. Colloids, mainly hydroxyethyl starch, should not be recommended. Moderate-rate fluid infusion seems to be an advantage over high-rate infusion. Relying on presented results, fluid therapy has a key therapeutic role in AP management.