ABSTRACT
Introduction: Data driven management strategies for acute pancreatitis (AP) in pediatrics have been limited. Adult data suggests use of lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes. The first management guideline for pediatric patients based on a standardized definition of AP severity was published in 2018;it described the need for early aggressive fluid resuscitation, but had insufficient data to recommend a specific fluid. Objective(s): To evaluate the efficacy of LR as the intravenous fluid (IVF) during the first 48 hours of an AP episode compared with NS. Study Design: A prospective multi-site randomized controlled clinical trial, started in 2016 at Children's Hospital of The King's Daughters, (Clinical Trials.gov NCT03242473), expanded to Children's National Hospital (2017), and to Cincinnati Children's Hospital Medical Center (CCHMC) (2018). Eligible patients (<19 years) diagnosed with first episode of AP were enrolled within 6 hours of presentation and were randomized to either LR or NS. A comprehensive biochemical profile was obtained at admission, and at 24 and 48 hours from time of admission. Vital signs, SIRS status, and signs of complications of AP were monitored. Clinical decisions regarding management (e.g. discharge criteria) were determined by the primary clinical team. Recruitment was stopped in the spring of 2020 due to the SARS-CoV2 pandemic. Primary outcomes were C-Reactive Protein (CRP) values at 24 and 48 hours after admission;secondary outcomes were changes in labs, SIRS status length of stay, time to initation of feeds, and development of severe AP (SAP). Result(s): There were 76 eligible patients (38 LR, 38 NS). There was no significant differences in baseline characteristics or AP etiology for either group (Table 1). There was no significant differences in initial biochemical profile except a slightly elevated anion gap in the LR group (Table 2). There was a higher proportion of patients in the LR group (32%, 12/38) discharged before 48 hours compared to NS (13%, 5/38) (Table 3). The LR group had a significantly higher rate of discharge within the first 72 hours compared to the NS group (p=0.02) (Figure 1a and 1b). In the first 48 hours, there was no difference in the primary or most of the secondary outcomes measured (Table 3). Conclusion(s): Use of LR was associated with a faster rate of discharge in the first 72 hours and had no significant negative outcomes associated with its use. No other significant differences in overall outcomes were identified with the use of LR or NS during hospitalization for AP in this study. This reduction in length of hospitalization has significant implications for patients as well as healthcare expenditures. This data suggests that early resuscitation with LR may be beneficial to recovery, particularly in patients more likely to have mild AP, who may be able to be identified early in the hospital course. Future pediatric AP studies will be required to confirm these findings. (Table Presented).