FLUID resuscitation in acute pancreatitis is associated with differences in hospital length of stay, with new data suggesting that both crystalloid type and administration rate interact to influence outcomes in patients with mild disease.
Fluid Resuscitation in Acute Pancreatitis
Fluid resuscitation in acute pancreatitis remains a cornerstone of early management, yet uncertainty persists regarding optimal crystalloid selection and infusion strategy. This retrospective cohort study evaluated how crystalloid type and administration rate were independently and jointly associated with hospital length of stay in patients with mild acute pancreatitis.
The analysis included 204 patients admitted between 2018 and 2024. Patients were grouped according to crystalloid type, including Lacted Ringer’s (LR) solution, normal saline NS, Isolyte S, and dextrose containing solutions. Resuscitation rates were classified as aggressive, moderate, minimal, or low. Outcomes were assessed using multivariable linear regression and stratification by Bedside Index for Severity in Acute Pancreatitis score.
Interaction Between Crystalloid Type and Infusion Rate
Findings showed that LR solution and NS were associated with comparable hospital length of stay, with no statistically significant difference observed between the two (p=0.24). However, both were associated with significantly shorter stays compared with Isolyte S and dextrose containing solutions (p<0.001).
A significant interaction was observed between crystalloid type and resuscitation rate in fluid resuscitation in acute pancreatitis. LR solution and NS delivered at moderate to aggressive rates were associated with the shortest hospital stays. In contrast, Isolyte S and dextrose containing solutions administered at low rates were associated with the longest stays.
Multivariable analysis identified crystalloid type, resuscitation rate, Bedside Index for Severity in Acute Pancreatitis score, age, and hypertension as independent predictors of length of stay. These associations remained consistent across severity subgroups.
Clinical Implications
The authors report that fluid resuscitation in acute pancreatitis should consider both crystalloid composition and infusion rate together rather than in isolation. While LR solution and NS demonstrated similar outcomes, both were associated with shorter hospitalisation compared with other fluids evaluated.
The findings suggest that NS may represent a reasonable alternative when LR solution is not available. The authors conclude that optimisation of fluid resuscitation in acute pancreatitis may benefit from an integrated approach that accounts for both fluid type and administration rate when managing mild disease.
Reference
Bozkurt E et al. Which fluid resuscitation strategy is associated with shorter length of stay in mild acute pancreatitis? Interaction between crystalloid type and administration rate. BMC Gastroenterol. 2026;DOI:10.1186/s12876-026-05016-9.
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