Liquid and volemic disorders in patients with different forms of acute pancreatitis after initiation of infusion therapy
Background. The incidence of acute pancreatitis (AP) and the increasing severity of its course are increased throughout the world reaching 67–70 people per 100,000 population in Ukraine. The strategy of conservative management of a patient with AP in the early phase determines the importance of homeostatic restoration of liquid compartments, which provides systemic, organ and tissue circulation. The purpose of the study: to determine the degree of damage to liquid compartments in various forms of acute pancreatitis after initiation of infusion therapy. Materials and methods. The results of a cohort prospective observation conducted in 2015–2018 are presented. The basis of the retrospective analysis is the clinical data of 61 patients with diagnosed AP. Age of patients — 46.6 ± 9.8 years; among them — 25 (41 %) women and 36 (59 %) men; average body mass 77.8 ± 6.0 kg. Baseline α-amylase was elevated to 211 ± 36 U/l, urine diastase — up to 1024 ± 74 U/l. Formation of groups for analysis is performed after initiation of infusion therapy with balanced isotonic saline solutions; determination of AP course — after the end of treatment. Results. When patients were admitted to the intensive care unit, hypovolemia due to the plasma loss was dominated on the background of acute surgical dehydration degree II–III: Ht — 59 ± 4 %, heart rate — 118 ± 6 bpm,
total serum protein — 79.9 ± 6.1 g/l. Clinical response to the initial infusion was associated with the severity of the subsequent course of the disease in accordance with the etiological factor of AP: alimentary, hepatobiliary, and traumatic. Then, if AP was not complicated, the volume of intravenous resuscitation during the first day of treatment was 2591 ± 961 ml (33.1–36.2 ml/kg), on day 2 — decreased to 1958 ± 490 ml (25.5–27.8 ml/kg). During the first 12 hours of treatment, the diuresis reduced to 500 ml, increased to 0.8–
1.0 ml/kg/h only by the end of the second day against the background of fluid recovery. In severe and complicated course of AP, the initial volume of combined intravenous resuscitation was 3304 ± 310 ml during the first day of treatment (42.6–45.7 ml/kg),
on the second day, it reduced to 2384 ± 309 ml (24.3–28.7 ml/kg),
and did not decrease on day 3. The final and initial oliguria in these patients is greater than in the first 12 hours of treatment, the diuresis is reduced to 250 ml, its spontaneous recovery is delayed by 24–32 hours against the background of combined liquid resuscitation, which was initially carried out for at least 5 days in the intensive care unit. Conclusions. The response to the initial infusion is associated with the severity of the further course of the disease and the etiological factor of AP, depending on the degree of acute surgical dehydration due to the severity of damage to the pancreas. In the uncomplicated course of alimentary interstitial edematous pancreatitis, on the background of the initial infusion, there is a clinical improvement, early rehydration and remobilization of deposited liquid. In severe AP, despite the timely start of combined infusion therapy in the early phase, there are systemic fluid violations against the background of persistent organ failure of varying severity; due to the formation of sequestered fluid formations, no proper re-mobilization of the initially deposited liquid occur. In acute biliary pancreatitis, after the beginning of infusion therapy, visceral disorders dominate: signs of biliary hypertension mainly due to choledocholithiasis, cholestasis and inflammation of the biliary tract supporting secondary disorders in fluid compartments.
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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al, Acute Pancreatitis Classification Working Group. Classification of Acute Pancreatitis ‒ 2012: revision of the Atlanta classification and definitions by International Сonsensus. Gut. 2013;62(1):102–11. doi:10.1136/gutjnl-2012-302779. URL:https://gut.bmj.com/sites/default/themes/bmjj/img /logos/ logo-bmj-journals.svg.
Tenner S, Baillie J, DeWitt J, Vege SS: American College of Gastroenterology. Management of Acute Pancreatitis: American College of Gastroenterology Guideline. Am J Gastroenterol. 2013 Sep;108(9):1400-15; 1416. doi: 10.1038/ajg.2013.218. PMID: 12548055.
Shy`yan A.S., Muryzina OYu. Obgruntuvannya infuzijnoyi terapiyi u paciyentiv z rizny`my` formamy` gostrogo pankreaty`tu u rannyu fazu zaxvoryuvannya [Rationale of infusion therapy in patients with various forms of acute pancreatitis in the early phase of the disease] Zb. mat. XVIII konf. stud. ta mol. ucheny`x Novy`ny` i perspekty`vy` medy`chnoyi nauky` [Proc. XVIII Conf. studio and say scientists “News and prospects of medical science“ ed. Tverdoxlib IV, Bondarenko NS] Dnipro, 2018; p. 44–5. Ukranian.
Phillip V., Steiner J.M., Algül H. Early phase of acute pancreatitis: Assessment and management. World J Gastroenterol. 2014 Aug 15; 5(3): 158–168 . [PubMed] doi: 10.4291/wjgp.v5.i3.158.
Fisher JM., Gardner TB. The “golden hours” of management in acute pancreatitis. Am J Gastroenterol. 2012 Aug;107(8):1146-50. doi: 10.1038/ajg.2012.91.
Warndorf MG, Kurtzman JT, Bartel MJ, Cox M, Mackenzie T, Robinson S, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. Aug;9(8):705-9. doi: 10.1016/j.cgh.2011.03.032. PMID: 21554987.
Hamada Sh., Masamune A., Shimosegawa T. Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey. World J Gastroenterol. 2017;23(16):2826-2831. doi: 10.3748/wjg.v23.i16.2826.
Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis Can J Surg. 2016 Apr;59(2): 128–40. doi:10.1503/cjs.015015 PMCID:PMC4814287.
NICE Guidance. Intravenous fluid therapy in adults in hospital. Clinical guideline [CG174]. Published date: December 2013. Last updated: May 2017 : веб-сайт. URL: https://www.nice.org.uk/guidance/cg174/chapter/1.Recommendations (accessed 15.02.2018).
Woodcock T. GIFTAHo; an improvement on GIFTASuP? New NICE guidelines on intravenous fluids. Anaesthesia. 2014 May;69(5):410-5. doi: 10.1111/anae.12644.
Padhi S, Bullock I. Li L, Stroud M; National Institute for Health and Care Excellence (NICE) Guideline Development Group. Intravenous fluid therapy for adults in hospital: summary of NICE guidance. BMJ. 2013 Dec 10;347:f7073. doi: 10.1136/bmj.f7073. PMID:24326887.
Marx G, Schindler AW, Mosch C, Albers J, Bauer M, Gnass I, et al. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol. 2016 Jul;33(7):488‒521. doi: 10.1097/EJA.0000000000000447. MID:27043493. PMCID: PMC4890839.
Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015 Jun;22(6):405‒32. doi: 10.1002/jhbp.259. PMID:25973947.
Aggarwal A, Manrai M, Kochhar R. Fluid resuscitation in acute pancreatitis. World J Gastroenterol. 2014;20(48):18092‒103. doi: 10.3748/wjg.v20.i48.18092. PMID: 25561779.
Calamo-Guzman B., Vinatea-Serrano L, Piscoya A. In response to fluid resuscitation with lactated Ringer’s solution vs. normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial / United Eur Gastroenterol J. 2018 Apr; 6(3):480–1. doi: 10.1177/2050640617753281.
Talukdar R, Bhattacharrya A, Rao B, Sharma M, Reddy N D. Clinical utility of the revised Atlanta classification of acute pancreatitis in a prospective cohort: have all loose ends been tied? Pancreatology. 2014 Jul-Aug;14(4):257-62. doi: 10.1016/j.pan.2014.06.003.
Nesvaderani M., Eslick GD, Vagg D., Faraj S., Cox MR. Epidemiology, aetiology and outcomes of acute pancreatitis: A retrospective cohort study. Int J Surg. 2015;23(Pt A):68-74. doi: 10.1016/j.ijsu.2015.07.701. PMID: 26384834.
Roberts SE, Akbari A, Thorne K, Atkinson M, Evans PA. The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors. Aliment Pharmacol Ther. 2013 Sep;38(5):539‒48. doi: 10.1111/apt.12408. PMID:23859492 PMCID: PMC4489350.
Weitz G, Woitalla J, Wellhöner P, Schmidt K, Büning J, Fellermann K, et.al. Detrimental effect of high volume fluid administration in acute pancreatitis - a retrospective analysis of 391 patients. Pancreatology. 2014;14(6):478-83. doi: 10.1016/j.pan.2014.07.016.
Singh H, Gougol A, Mounzer R, Yadav D, Koutroumpakis E, Slivka A, et al. Which Patients with Mild Acute Pancreatitis Require Prolonged Hospitalization? Clin Transl Gastroenterol. 2017 Dec 7;8(12):e129. doi: 10.1038/ctg.2017.55.
Madaria E, Banks PA, Moya-Hoyo N, Wu BU, Rey-Riveiro M, Acevedo-Piedra NG, et al. Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2014 Jun;12(6):997‒1002. doi: 10.1016/j.cgh.2013.10.017.
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