What's the Best Fluid for Pancreatitis?

Could it possibly be (anything but normal saline)?

A stepped-wedge trial out of China testing normal saline against “balanced multi-electrolyte solution” in patients with fairly severe pancreatitis (pSAP > 8, CRP > 150). The primary outcome, because this is the outcome that matters most to clinicians, patients, and their families: “serum chloride concentration on day 3”.

In this trial, the BMES was:

Here’s what their primary outcome looked like:

So, make sense, right? Giving more chloride increases your chloride concentration!

Secondary clinical outcomes were nearly all identical. There were baseline differences between the groups with respect to respiratory failure on admission, etiology of pancreatitis, age, etc., so the few outcome differences favoring BMES (ventilator-free days!) they teased out are probably not reliable. The trial was also conducted and funded by folks working for a Chinese pharmaceutical industry involved with the manufacture of the balanced solution.

All these problems aside, normal saline is basically well-established as The Worst. You’ll rarely be wrong reaching for an alternative, balanced solution for general cases of fluid administration. Nothing earthshaking here, but at least nothing surprising, either.