Fluid Resuscitation Choice and its Effect on Plasma Chloride and Acute Kidney Injury in Severe Acute Pancreatitis: A Randomized Study of Normal Saline vs. Balanced Crystalloids (Physiomax).

Background: Acute pancreatitis (AP) is a potentially fatal gastrointestinal condition, often associated with organ failure and acute kidney injury (AKI). Early fluid resuscitation with Normal saline (NS) may lead to hyperchloremia and AKI, which prompted interest in using balanced crystalloids. However, the optimal choice of crystalloid fluid remains uncertain. This study aimed to compare the effects of NS versus Physiomax on plasma chloride levels and AKI incidence during early resuscitation in patients with predicted severe AP (pSAP). Methods: A single-center, prospective, randomized study was conducted between November 2022 and December 2023 at PGIMER, Chandigarh, India. 112 patients with pSAP were enrolled and randomized (1:1) to receive either NS or Physiomax for fluid resuscitation over the first 48 h. Primary outcome was plasma chloride concentration at 48 h. Secondary outcomes included AKI incidence, MAKE-30 events, ICU admissions, and mortality. Results: Baseline and clinical parameters were comparable between groups. At 48 h, plasma chloride levels were significantly higher in NS group (114.1 ± 4.3 mmol/L) versus Physiomax group (108.1 ± 3.2 mmol/L; p < 0.001). AKI occurred in 41 % of NS group while 21.4 % in Physiomax group (p = 0.03). MAKE-30 events were more common in NS group (17.9 % vs. 5.4 %; p = 0.008). ICU admission rates were also significantly higher with NS infusion (28.6 % vs. 10.7 %; p = 0.03). No significant differences in hospital length of stay, mortality, or other complications were observed in between groups (p > 0.05). Conclusion: Physiomax significantly reduced plasma chloride levels and AKI incidence in patients with pSAP, suggesting a potential clinical benefit of balanced crystalloids in early AP resuscitation.