Background Early fluid resuscitation is recommended for the therapy of acute pancreatitis in order to prevent complications. However, studies have shown a higher rate of local and systemic complications in patients treated with more aggressive fluid therapy. Since chloride administration may cause systemic inflammatory response and renal failure, the detrimental effect of volume therapy might be attributed to the chloride content of the administered fluid. Methods We reviewed 493 consecutive cases of confirmed acute pancreatitis treated with a wide range of fluid amounts with different chloride concentrations. We tested whether rise of C-reactive protein within the first week (ΔCRP), local complications, and organ failure could be predicted by the amount of administered chloride. Results The recorded fluid administered within the first 24 hours was 3856 (2400-5000) mL (median [1st; 3rd quartile]). The amount of administered chloride was 508 (348-666) mmol. Chloride was related to ΔCRP with a rise of approximately 9.0 mg/L C-reactive protein per 100 mmol administered chloride. ΔCRP was predictable by the administered volume and chloride with a stronger effect for chloride. Chloride administration had no effect on local complications or organ failure. ΔCRP was, however, related to outcome parameters (p=0.0062 for organ failure, p<0.001 for local complications, necrosis, and persistent organ failure). Conclusion Chloride administration in acute pancreatitis may contribute to the systemic inflammatory response. Although inflammation and outcome were closely related, chloride administration had no measurable impact on outcome. The rise of C-reactive protein in patients with unfavourable outcome must rather be attributed to other factors than chloride.
Gunther Weitz, Felix Miernik, Florian Bär, Jürgen Büning, Inke R König