A 35 year old man presents with Acute Pancreatitis. The ideal fluid of choice in the initial management is
Correct Answer: Isotonic crystalloid
Description: (A) Isotonic crystalloid[?]INITIAL MANAGEMENT:oCrystalloids: Ringer's lactate or Normal saline.oWhile crystalloids appear to be the Ideal Choice based on expert opinion & the guidelines/recommendations from America, Italy & Japan.oThese recommendations are not based on high - level evidence in patients with acute pancreatitis.ADVANTAGES & DISADVANTAGES OF DIFFERENT FLUID TYPES IN RESUSCITATIONFluid TypeAdvantagesDisadvantagesIsotonic crystalloids (lactated Ringer's solution, 0.9% sodium chloride, Normosol-R, Plasmalyte A)*. Los cost*. Necessary in dehydration*. Widely available*. Large volumes needed*. Longer time to resuscitate*. Require more technical staff (E.g., Placement of multiple, large-guage IV catheters)*. Risk of hypothermia*. Risk of interstitial edema*. Risk of hemodilution*. Risk of re-bleedingHypertonic saline*. Low cost*. Small volumes needed for rapid resuscitation*. Minimizes risks of interstitial edema*. Beneficial neurological effects; decreases intracranial pressure*. Immunomodulatory effects*. Beneficial cardiac effects*. Short acting when used alone*. Transient hypernatremia*. Hypotension, bronchoconstricction, or arrhythmias with rapid administration*. Risk of volume overload*. Possible phlebitis*. HyperosmolarSynthetic colloids (6% hetastarch, 10% pentastarch, 6% dextran 70)*. Smaller volumes needed for rapid resuscitation compared with crystalloids*. Minimizes risks of interstitial edema*. Longer duration of effect*. Increases COP*. Less hemodilution*. Higher cost*. Risk of volume overload*. Exacerbation of coagulopathies*. Risk of allergic reactions*. Edema with vasculitis*. Interference with cross-matchingHemoglobin-based oxygencarrier (Oxyglobin)*. Increases COP*. Increases oxygen delivery*. Eliminates need to cross-match*. 2 year shelf life*. Higher cost*. Risk of volume overload*. Possible risk of anaphylaxis with multiple uses*. Inability to measure certain blood values after useoAggressive hydration, defined as 250-500 per hour of isotonic crystalloid solution should be provided to all patients, unless cardiovascular, renal or other related co-morbid factors exist.oEarly aggressive intravenous hydration is most beneficial during the first 12-24 hr, and may have little benefit beyond this time period.oIn a patient with severe volume depletion, manifest as hypotension & tachycardia, more rapid repletion (bolus) may be needed.
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