LEARNING OBJECTIVE

After this activity, the participant will be able to identify best clinical practices regarding the choice of intravenous fluids when managing patients with acute pancreatitis (AP) in the first 24 hours.

QUESTION 1

Which of the following statements regarding the management of AP is correct?

Early large-volume fluid administration in AP is harmless Assessment of AP severity is currently based on individual clinician judgment There is a clear consensus on the initial choice of intravenous (IV) fluids Diagnosis of AP requires the presence of at least 2 of the 3 criteria QUESTION 2

A 52-year-old man came to the emergency department with abdominal pain and nausea for the past 24 hours. The pain started a few hours after lunch as constant pain in the upper abdomen that radiated to his back and flanks. The patient also reported nausea, a few episodes of emesis, and abdominal distention. He reports drinking an average of 3–4 alcoholic drinks per day. Abdominal examination reveals tenderness and rigidity over the epigastric and periumbilical regions. Bowel sounds are diminished. Abnormal labs include a serum lipase of 1000 U/L (normal: 10–140 U/L) and blood urea nitrogen (BUN) of 30 mg/dL (normal: 8–20 mg/dL).

According to this study, which of the following may lead to improved outcomes in this patient's condition?

Infusion of lactated ringers (LR) in the first 24 hours Infusion of normal saline (NS) in the first 24 hours Infusion of combination fluids in the first 24 hours Infusion of colloids in the first 24 hours QUESTION 3

Which of the following statements is true based on this study?

NS use led to better outcomes over LR when patients with post-Endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis were excluded LR use led to better outcomes over NS even when patients with early organ failure were excluded NS use led to better outcomes over LR when patients who received >4 L in the first 24 hours were excluded Admission BUN level and systemic immune response syndrome (SIRS)-positive status did not predict outcomes in AP