Use of Lactated Ringers Solution Compared With Normal Saline Is Associated With Shorter Length of Stay in Pediatric Acute Pancreatitis

Abstract

Objective: The aim of the study was to evaluate lactated ringers (LR) versus normal saline (NS) in pediatric acute pancreatitis (AP).

Methods: This retrospective study used Pediatric Health Information System database of primary AP patients, 2013 to 2017.

Results: The study included 1581 first time AP patients with exclusive use of a single fluid (111 LR, 1470 NS) for the first 48 hours. The LR cohort had a significantly shorter length of stay (P < 0.001) compared with NS. A multivariable logistic regression analysis suggests use of NS in the first 48 hours (after controlling for total parenteral nutrition, operation, and infection during the admission) had a significantly increased likelihood of requiring a hospitalization for 4 days or more compared with the LR group (odds ratio, 3.31; 95% confidence interval, 1.95-5.62). The overall cost was significantly less in the LR group. There was no statistical difference observed in risk factors for AP, intensive care transfer, organ dysfunction, or mortality.

Conclusions: This represents the first large data set analysis of LR versus NS in pediatric AP. The use of LR was associated with a shorter length of stay and reduced cost compared with NS. Future randomized trials will help determine the ideal fluid choice for pediatric AP.

Conflict of interest statement

Conflict of Interest: The authors have declared that they have no relevant conflicts of interest to report.

Figures

FIGURE 1.

Percentage distribution of fluid choice by year, 2013–2017. The percentage of patients who received LR significantly increased annually from 2013 to 2017 (from 2.7% to 11.8%, P = 0.02).

FIGURE 2.

Comparison of LOS in days between LR and NS*. AP Patients that received LR (median 2 days with IQR 1–3 days) had a significantly shorter LOS (P < 0.001) compared to those who received NS (median 3 days with IQR, 2–5 days) using a Wilcoxon-Mann-Whitney test for analysis. *Outliers greater than 10 days were excluded for graphical purposes but were included in the analysis.