Management of Fluid Therapy in Acute Alcoholic Pancreatitis

Abstract. Acute alcoholic pancreatitis (AAP) represents a significant cause of hospitalizations in surgical departments, with severe cases leading to multi-organ failure and high mortality rates, up to 30%. Effective management of AAP requires accurate patient condition assessment, which directly influences treatment strategies, including fluid resuscitation, pain relief, nutritional support, and antibiotic use. A key factor in AAP outcomes is the development of hypovolemia, caused by fluid loss into the peritoneal and retroperitoneal spaces, exacerbating systemic and local hypoperfusion, tissue ischemia, and pancreatic necrosis. Proper fluid therapy is essential to prevent both hypovolemia-related complications and fluid overload, which may lead to pleural effusion, cerebral edema, and cardiovascular dysfunction. Current guidelines for fluid therapy in AAP focus on maintaining specific physiological parameters such as mean arterial pressure, heart rate, central venous pressure, urine output, and hematocrit levels. However, the use of non-invasive methods like bioimpedance analysis, which measures tissue resistance to determine fluid distribution, may offer more precise insights into the patient's fluid status, enabling better management of infusion therapy. The aim to optimize fluid management in patients with moderate to severe AAP and reduce infectious complications through the use of bioimpedance analysis. Materials and methods. A total of 110 patients were enrolled, including 101 men and 9 women. The patients were divided into two groups: one treated with standard fluid therapy using Ringer's lactate solution and the other receiving Sterofundin ISO solution, with infusion volumes adjusted according to bioimpedance measurements. Laboratory tests, including procalcitonin levels and the Limulus amebocyte lysate (LAL) test, were used to monitor inflammatory markers and endotoxin levels, while bioimpedance measurements were conducted on days 1, 3, 5, 8, 11, and 14 to dynamically assess fluid balance. The results showed that patients treated with Sterofundin ISO and bioimpedance-guided fluid management experienced a significant reduction in extracellular fluid volume deviations and infectious complications compared to those receiving standard treatment. In the second group, the incidence of infectious complications in patients with moderate AAP decreased from 35.9% to 21.62%, and in severe cases, from 81.3% to 44.45%.. Key words: acute alcoholic pancreatitis, LAL-test, bioimpedance measurement, infusion, infectious complications