Clinical efficacy of remaxol in the volume infusion therapy of acute pancreatitis

O.M. Klygunenko, O.Yu. Muryzina


Background. In Ukraine, as elsewhere in the world, there is a tendency to increase in the incidence of acute pancreatitis (AP), which causes the primary disability of patients or, if the course is unfavorable, leads to multiple organ failure (multiple organ dysfunction syndrome — MODS) and a possible fatal outcome of the disease. The AP causes pathological sequestration of the fluid in the retroperitoneal space and splanchnic vascular system, causing deep fluid disorders, reduction of porto-hepatic circulation with a violation of the trophic reserve of blood circulation and cellular homeostasis, especially in parenchymal organs. The basis for the application of a balanced polyionic solution containing amber acid is the ability of the succinate to support synthesis and maintain cellular energy under acute metabolic disturbance and exhausted energy resources. The purpose of the study is to improve the treatment of patients with various forms of acute pancreatitis by optimizing infusion therapy by restoring energy deficiency in the tissues of the body and enhancing natural detoxification systems. Materials and methods. The early period of intensive care was studied prospectively in 120 AP patients, 81 (67.5 %) men and 39 (32.5 %) women aged 46.6 ± 12.7 years. The primary distribution in groups was carried out according to the type of acute volemic disorders caused by AP. Group 1 — primary dehydration degree II, APACHE II — 13 [10, 14] points, organ failure according to the modified MODS — 2 [1, 2]: 1a subgroup (controls) — 24 (20 %) patients who underwent standard volemic resuscitation without succinate; 1b subgroup — 71 (59.2 %) patients, a balanced solution containing remaxol pro infusionibus succinate was added to the basic resuscitation. Group 2 — 25 patients (20.8 %) with acute surgical dehydration degree III and predicted severe course of AP; APACHE II — 19 [16, 24] points, MODS — 3. Results. In all patients with AP, the primary acute surgical dehydration degree II and III was detec­ted, it was associated with the systemic inflammatory response syndrome (SIRS), mild (heart rate — 118 ± 5 bpm, leukocytosis — 14.6 ± 1.3 · 109/l, neutrophil left shift — 13.8 ± 1.5 %) or moderate (body temperature was 38 °C) degree. After 72 hours of treatment, the severity of leukocytosis and shift were 11 % lower (p < 0.02) in those patients who received remaxol three times. At day 5 of treatment in patients receiving remaxol (1b subgroup), the levels of α-amylase, bilirubin, transaminases were within the reference range. When using remaxol, persistent organ failure was observed in 7 % of cases (5 patients), in contrast to the patients in the 1a subgroup who did not receive remaxol — 12.5 % (3 patients), and a regression of persistent manifestations occurred during the fourth day of observation, whereas in 1a subgroup after 72 hours, 2 (8.3 %) patients had a repeated deterioration of the clinical condition due to necrotic damage to the pancreas. Against the background of remaxol, all organ disorders developed 9.1 % less frequently than in 1a subgroup, and the severe course of AP was detected 6.8 % less frequently. Conclusions. The use of remaxol in the early period of the AP reduces the manifestations of intrahepatic cholestasis, cytolysis, nonspecific mesenchymal inflammation, exhibits hepatoprotective effect, preserves metabolic, homeostatic and detoxification functions of the liver; slows down the progression of SIRS and organ disorders, creates the conditions necessary for optimizing reparative processes in the pancreas, regardless of the severity of the AP; provides effective clinically significant (in 16 % of cases) redistribution of patients towards the moderate (mild) AP, promotes mostly uncomplicated, mostly moderate AP and regression of transient and persistent organ failure, slows down the development of MODS and the progression of pancreatic necrosis in the severe course of AP.


acute pancreatitis; acute dehydration; acute mitochondrial dysfunction; hepatosplanchnic insufficiency; infusion therapy; succinate; balanced solution; remaxol


Banks PA., Bollen TL, Dervenis C, Gooszen HG., Johnson C.D., Sarr M.G., Tsiotos G.G., Vege S.S. Acute Pancreatitis Classification Working Group Classification of Acute Pancreatitis ‒ 2012: revision of the Atlanta classification and definitions by International Сonsensus. Gut advance online publication 2013;62(1):102–11. doi:10.1136/gutjnl-2012-302779.

Maksymiuk VV. [Acute pancreatitis: mechanisms of development and new approaches to diagnosis, prognosis and treatment]. Buk. Med. Herald 2016; 20, 2 (78):81‒84. Ukranian.

Bereznytskyi YaS, Duka RV, Malinovskyi SL, Gryb EV, Gryniuk SV, Mateshchuk NV, Levchenko TV. [Results of treating patients with acute pancreatitis in a multidisciplinary surgical hospital]. Zbirnyk naukovykh prats' spivrobitnykiv NMAPO im. P. L. Shupyka = Collection of Scientific Works of Staff Members of P.L. Shupyk NMAPE 2014; 23(2): 54‒61. Ukranian.

Tenner S, Baillie J, DeWitt J, Swaroop Vege S. Management of Acute Pancreatitis [Electronic resource]. Am J Gastroenterol 2013; 108 (9):1400–15; doi:10.1038/ajg.2013.218;

Bylik IS, Ivashchuk SІ. [Structural changes of the pancreas in patients with acute pancreatitis considering the lipid profile]. Buk. Med. Herald. 2016; 20, 1 (77): 3–7. Ukranian.

Datsyuk ОІ, Titarenko NV. [Systematic review of studies of infusion therapy in the treatment of acute pancreatitis]. Emergency medicine. 2015; 7(70): 31–34. Ukranian.

Petrushenko VV, Stolyarchuk AV. [Oxidative stress in patients with acute pancreatitis and its association with systemic inflammatory response syndrome and organ dysfunction]. Emergency medicine. 2016; 2(73): 128–132. Ukranian.

Maltseva LA, Kutovoj AB, Kobelyatsky YuYu, Nesterenko AN, Mosentsev NF. (2014). Ostryie pankreatityi: epidemiologiya, etiologiya, patogenez, intensivnaya terapiya, hirurgicheskoe lechenie [Acute pancreatitis: epidemiology, etiology, pathogenesis, intensive care, surgical treatment], in Maltseva LA. (ed.). Dnepropetrovsk, LizunovPress, 192 p. Ukraine.

Anand N., Park JH., Wu BU. Modern management of acute pancreatitis Gastroenterol. Clin North Am 2012; 41, 1: 1–8. doi: 10.1016/j.gtc.2011.12.013.

IAP/APA evidence-based Guidelines for the management of acute pancreatitis / Working Group IAP/APA Acute Pancreatitis Guidelines // Pancreatology advance online publication 2013; 13 (4 Suppl 2):e1–e15.

Кryvoruchko ІА, Kopchak VM, Usenko ОYu, Goncharova NМ, Balaka SМ, Теslenko SМ, Аndreyeshchev SА. [Classification of an acute pancreatitis: revision by international consensus in 2012 of classification, adopted in Atlanta]. Clin Surgery 2014;9:19–24. Ukranian.

Cairns CB, Ferroggiaro AA, Walther JM, Harken AH, Banerjee A. Postischemic administration of succinate reverses the impairment of oxidative phosphorylation after cardiac ischemia and reperfusion injury. Circulation 1997; 96 (9): II–260–5. [Google Scholar], [Medline], [ISI].

Hawkins BJ, Levin MD, Doonan PJ, Petrenko NB, Davis CW, Patel VV, Madesh M. Mitochodrial complex II prevents hypoxic but not calcium- and proapoptotic Bcl-2 protein-induced mitochondrial membrane potential loss. J Biol Chem 2010; 285(34): 26494‒505 doi: 10.1074/jbc.M110.143164. [PubMed].

Weinberg JM, Venkatahalam MA, Roeser NE, Nissim I. Mitochondrial dysfunction during hypoxia/reoxygenation and its correction by anaerobic metabolism of citric acid cycle intermediates. Proc Natl Acad Sci USA 2000; 97: 2826‒31. [PubMed].

Lukyanova LD. [Mithochondria signaling in adaptation to hypoxia]. Fiziol Zh 2013; 59, 6: 141‒153. Russian.

Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта