Reanimación con Líquidos Intravenosos en Pancreatitis Aguda: Tratamiento Basado en Evidencia
El manejo temprano de líquidos intravenosos es fundamental en el tratamiento de la pancreatitis aguda. El enfoque depende del estado volumétrico del paciente al momento de la presentación y requiere una reevaluación estructurada durante las primeras 24–48 horas para orientar la reanimación continua.
Objetivos Clínicos del Tratamiento
El objetivo principal de la terapia de líquidos es la disminución del BUN y la hemodilución (descenso del hematocrito), que reflejan una perfusión renal adecuada y la restauración del volumen. El estado hídrico se reevalúa formalmente dentro de las 6 horas posteriores a la presentación y se monitoriza durante las 24–48 horas siguientes.
References
DOI: 10.14309/ajg.0000000000002645
- We suggest moderately aggressive fluid resuscitation for patients with AP.
- Additional boluses will be needed if there is evidence of hypovolemia.
- We suggest using lactated Ringer solution over normal saline for intravenous resuscitation in AP.
- From this study, we can conclude that in patients with no evidence of hypovolemia, an initial resuscitation rate of no more than 1.5 mL/kg of body weight per hour should be administered.
- However, in patients with hypovolemia, clinicians should administer a bolus of 10 mL/kg.
- While the presence of hypovolemia might demand higher amounts and rates of hydration, most patients with AP will likely benefit from 3-4 L the first 24 hours, depending on body mass index.
- Fluid volumes need to be reassessed at frequent intervals within 6 hours of presentation and for the next 24-48 hours with a goal to decrease the BUN.
- In general, intravenous hydration providing for a decrease in the HCT (hemodilution) and/or decreased BUN (increased renal perfusion) have been shown to be associated with decreased morbidity and mortality.