Retrospective Analysis Assessing Adequate IV Fluid Hydration in the Emergency Department in Patients With a Diagnosis of Acute Pancreatitis

Introduction: According to ACG guidelines for acute pancreatitis treatment, initial management includes aggressive hydration defined as 250-500 mL/hr of isotonic crystalloid solution, unless cardiovascular, renal, or other comorbid factors exist. Aggressive hydration is most beneficial during the first 12-24 hours and may have little benefit beyond this time period (1). Early aggressive fluid resuscitation (>1000 mL in the Emergency Department (ED)) when compared to nonaggressive (<500 ml) was associated with decreased morbidity and mortality (2). Based on the literature, adequate hydration includes bolus and rate of infusion of at least 1 L and 250 mL/hr, respectively. The purpose of our study is to evaluate if patients diagnosed with acute pancreatitis are receiving adequate fluid hydration in our ED. Methods: In this retrospective study, a report was generated containing a list of patients ≥18 years who were diagnosed with acute pancreatitis (first or recurrent) in the ED in 2017. A chart review was performed to obtain the patient's gender, age, cause of pancreatitis, type and amount of bolus infusate, type and rate of infusion infusate received in the ED and if there was a reason provided in the ED provider's note for patients receiving less than 1L bolus and less than 250 mL/hr fluid. Patients that were initially diagnosed with pancreatitis in ED but were determined to have an alternate diagnosis after further analysis were excluded from the study. Results: A total of 100 patients were diagnosed with acute pancreatitis in the ED in 2017 (Table 1). Of which 28% of patients did not receive adequate fluid resuscitation. None of these patients had an explanation for the lack of adequate fluid administration in the ED physician's note. Conclusion: Based on our analysis, an unacceptably high percentage of patients are receiving inadequate fluid hydration in our ED. Providing education to the ED physicians regarding the importance of fluid hydration in patients with acute pancreatitis and appropriate documentation listing the reason for inadequate fluid administration is required to provide improved care.1130 Figure 1. Data analysis of the 100 patients diagnosed with acute pancreatitis in ED in 2017