Pancreatic Disorders & Therapy
Open Access

Innovations and Best Practices in Intravenous Fluid Therapy for Pancreatic Care

Kamo Parkhill^{* *}Correspondence: Kamo Parkhill, Department of Medicine, Saint Mary's University, Nova Scotia, Canada, Email:

Author info »

Description

Intravenous (IV) fluid therapy is a fundamental aspect of managing pancreatic disorders, particularly acute pancreatitis. Acute pancreatitis triggers a strong inflammatory response that causes fluid to shift from the bloodstream into the surrounding tissues—a process known as third-spacing. This results in significant fluid loss from the vascular compartment, leading to dehydration, low blood pressure, and impaired perfusion of vital organs including the pancreas itself. To counteract these effects, early and adequate IV fluid administration is critical to restore intravascular volume, maintain organ perfusion, and prevent complications such as shock and multiple organ failure. The goal of fluid therapy is to optimize tissue oxygenation and support pancreatic microcirculation, which can help limit pancreatic injury and necrosis [1-2].

Typically, isotonic crystalloid solutions such as Ringer’s lactate or normal saline are used. Ringer’s lactate is often preferred because it more closely mimics the body’s natural electrolyte balance and may reduce the risk of metabolic acidosis and systemic inflammation. The fluid rate is usually started at a moderate to aggressive pace (e.g., 250-500 mL/hour) in the first 24-48 hours but must be carefully tailored based on clinical parameters such as blood pressure, urine output, heart rate, hematocrit, and electrolyte levels [3-4].

Over-resuscitation can be harmful, potentially causing pulmonary edema, abdominal compartment syndrome, and increased intra-abdominal pressure, so frequent monitoring and adjustment of IV fluids are essential to balance adequate hydration with avoiding fluid overload. In chronic pancreatitis or other pancreatic disorders without acute inflammation, IV fluids are less commonly required but may be necessary during episodes of dehydration, pain crises, or if complications like pancreatic fistulas or infections arise. IV fluids are also crucial during surgery to maintain adequate circulating volume and tissue perfusion, compensating for blood loss and evaporative losses. In the perioperative period, careful fluid management contributes to better recovery, reduced complications, and shorter hospital stays [5-6].

Similarly, in intensive care units, tailored IV fluid therapy supports patients with sepsis, trauma, burns, and organ failure, where fluid balance is a delicate and dynamic challenge. Administration of IV fluids requires strict adherence to aseptic technique and careful monitoring. IV catheters must be regularly assessed to prevent complications such as phlebitis, infiltration, and infection. Fluid therapy should be frequently evaluated by monitoring vital signs, urine output, laboratory tests, and clinical parameters to ensure efficacy and safety. Adjustments may be necessary to respond to changes in the patient’s condition or treatment goals [7-8].

Recent advancements in IV fluid therapy emphasize individualized care and evidence-based protocols. Enhanced Recovery After Surgery (ERAS) programs advocate for goal-directed fluid therapy to optimize hemodynamics and reduce postoperative complications. Research also continues into novel fluid compositions and delivery systems to improve biocompatibility and reduce adverse effects. IV fluid therapy is not risk-free, even though it is used often. Excessive fluid delivery can result in fluid overload, which can worsen heart failure, cause pulmonary oedema, and compromise oxygenation. Conversely, inadequate fluid resuscitation may result in persistent hypoperfusion, organ dysfunction, and increased mortality. Electrolyte imbalances such as hypernatremia, hyponatremia, hyperkalemia, or hypokalemia require careful correction with appropriate fluid choices and rates [9-10].

Conclusion

Intravenous fluids are indispensable in clinical medicine, offering a rapid, effective means to restore and maintain vital physiological functions. Their appropriate selection and administration demand a thorough understanding of fluid physiology, patient-specific factors, and clinical context. As research and technology advance, IV fluid therapy continues to evolve, enhancing its role in patient-centered care and improving outcomes across diverse medical conditions. IV fluid therapy is a cornerstone in the supportive care of pancreatic disorders, particularly in acute pancreatitis, where timely and carefully managed fluid resuscitation improves clinical outcomes and reduces morbidity.

References

1. Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, et al. Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth. 2014;113(5):740-747.

   [Crossref] [Google Scholar] [Pubmed]

2. Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, et al. ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children-A systematic review and meta-analysis. Intensive Care Med. 2022;48(12):1691-1708.

   [Crossref] [Google Scholar] [Pubmed]

3. Scarlett CJ, Salisbury EL, Biankin AV, Kench J. Precursor lesions in pancreatic cancer: morphological and molecular pathology. Pathology. 2011;43(3):183-200.

   [Crossref] [GoogleScholar] [PubMed]

4. Soreide K, Weiser TG, Parks RW. Clinical update on management of pancreatic trauma. HPB (Oxford). 2018;20(12):1099-1098.

   [Crossref] [Google Scholar] [Pubmed]

5. Brossier DW, Goyer I, Verbruggen SC, Chaparro CJ, Rooze S, Marino LV, et al. Intravenous maintenance fluid therapy in acutely and critically ill children: state of the evidence. Lancet Child Adolesc Health. 2024;8(3):236-244.

   [Crossref] [Google Scholar] [Pubmed]

6. Rosendahl J, Bodeker H, Mössner J, Teich N. Hereditary chronic pancreatitis. Orphanet J Rare Dis. 2007; 2:1-10.

   [Crossref] [Google Scholar] [PubMed]

7. Mahajan A. Current status of role of serum amylase and lipase to triage blunt pancreatic trauma? J Clin Diagn Res. 2016;10(11):PL02.

   [Crossref] [Google Scholar] [Pubmed]

8. Gerzof SG, Banks PA, Robbins AH, Johnson WC, Spechler SJ, Wetzner SM, et al. Early diagnosis of pancreatic infection by computed tomography-guided aspiration. J Gastroenterol. 1987;93(6):1315-1320.

   [Crossref] [Google Scholar] [PubMed]

9. Mukai S, Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, et al. Expanding endoscopic interventions for pancreatic pseudocyst and walled-off necrosis. J Gastroenterol. 2015;50: 211-220.

   [Crossref] [Google Scholar] [PubMed]

10. Woodcock TE, Woodcock T. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012;108(3):384-394.

    [Crossref] [Google Scholar] [Pubmed]