The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-656 

Lactated Ringer's Vs Normal Saline for Acute 
Pancreatitis: An Updated Systematic Review and Meta-
Analysis 
Muhammad Aziz 1*, Zohaib Ahmed1, Simcha Weissman1, Sami Ghazaleh1, 
Azizullah Beran1, Faisal Kamal1, Wade Lee-Smith2, Ragheb Assaly3, Ali 
Nawras1, Stephen J Pandol1, Stephanie McDonough1, Douglas G. Adler4 

1Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 
2Department of University Libraries, The University of Toledo, Toledo, OH 43614 
3Division of Pulmonology and Critical Care, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 
4Director of Therapeutic Endoscopy and Director of Gastroenterology Fellowship 
Training Program University of Utah, School of Medicine, Salt Lake City, UT 84132 

*Corresponding author: Muhammad.Aziz@utoledo.edu

Published: 19 April 2023 

Introduction: Recent studies have evaluated and compared the efficacy of normal saline (NS) and 
lactated Ringer's (LR) in reducing the severity of acute pancreatitis (AP) and improving outcomes such 
as length of stay, the occurrence of the systemic inflammatory response syndrome (SIRS), ICU 
admission and mortality. We performed an updated systematic review and meta-analysis of the available 
studies to assess the impact of these fluids on outcomes secondary to AP. 

Methods: We systematically searched the following databases: PubMed/Medline, Embase, Cochrane, 
and Web of Science through February 8th, 2021 to include randomized controlled trials (RCTs) and 
cohort studies. Random effects model using DerSimonian-Laird approach was employed and risk ratios 
(RR) and mean difference (MD) with 95% confidence interval (CI) were calculated for binary and 
continuous outcomes, respectively.   

Results: 6 studies (4 RCTs and 2 cohort studies) with 549 (230 in LR and 319 in NS) were included. 
The overall mortality (RR: 0.73, CI: 0.31-1.69) and SIRS at 24 h (RR: 0.69, CI: 0.32-1.51) was not 
significantly different. The overall ICU admission was lower in LR group compared to NS group (RR: 
0.43, CI: 0.22-0.84). Subgroup analysis of RCTs demonstrated lower length of hospital stay for LR 
group compared to NS group (MD: 0.77 days, CI: 1.44 -0.09 days).   

https://dx.doi.org/10.46570/utjms.vol11-2023-656
mailto:Muhammad.Aziz@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-656 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-656 2 ©2023 UTJMS 

Conclusion: Our study demonstrated that LR improved outcomes (ICU admission and length of stay) in 
patients with AP compared to NS. There was no difference in rate of SIRS development and mortality 
between LR and NS treatments. 

https://dx.doi.org/10.46570/utjms.vol11-2023-656
https://dx.doi.org/10.46570/utjms.vol11-2023-656