Fluid therapy strategies in acute pancreatitis: Randomized controlled trial comparing dextran and Ringer's lactate

Acute pancreatitis (AP) is a frequent gastrointestinal emergency characterized by inflammation. It has the potential to progress to organ failure. Fluid therapy plays a critical role in early AP management, mitigating hypovolemia-induced ischemia and systemic inflammatory response syndrome (SIRS).

To evaluate dextran 40 + Ringer's lactate solution (RLS) vs RLS alone for fluid therapy in mild to moderate AP.

We conducted a single-center, single-blind, randomized controlled trial involving 108 patients with mild to moderate AP. Participants were randomized to receive either dextran 40 + RLS (1:3 ratio) or RLS alone. All patients underwent standardized, goal-directed fluid therapy and were monitored for clinical response, inflammatory markers, and complications. The primary outcomes were reduction in C-reactive protein (CRP) and resolution of SIRS at 72 hours. Secondary outcomes included organ failure, intensive care unit admission, mortality, and length of hospital stay.

The dextran 40 + RLS group demonstrated significantly lower CRP levels. No differences were observed in SIRS changes, fluid overload, refractory status mortality, local complications, or organ failure rates. Hospitalization tended to be shorter in the dextran 40 + RLS group (5 days vs 6 days) although not to a statistically significant level (P = 0.1). Adverse events were mild and comparable in both groups.

Dextran 40 + RLS improved the early CRP response in patients with AP without added complications. Although medium-term outcomes were similar, early benefits support its use in initial management.