Lactated Ringer Versus Normal Saline for Fluid Resuscitation in Acute Pancreatitis: A Systematic Review

Acute pancreatitis (AP) requires early fluid resuscitation, and the optimal choice of fluid remains uncertain. This review compared lactated Ringer (LR) with normal saline (NS) in adult AP, with a primary focus on systemic inflammatory response syndrome (SIRS) at 24 hours. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, this review explored PubMed, ScienceDirect, ClinicalTrials.gov, Europe PMC, EBSCO Open Dissertations, and the Cochrane Library for studies published from January 1, 2015 to October 31, 2025. We screened titles and abstracts of 1,324 records and 14 full-text reports. Out of the 14 reports, six met the inclusion criteria of our review. This included three small randomized controlled trials (RCTs) and three meta-analyses (MAs). Throughout the review, LR was consistently associated with lower rates of intensive care unit (ICU) admissions. In addition, short-term inflammatory markers - such as SIRS and C-reactive protein (CRP) - tended to demonstrate earlier improvement with LR, while findings related to mortality and length of hospital (LOH) stay were less consistent and often did not reach statistical significance. Early fluid resuscitation is a central part of AP care, yet the optimal crystalloid has remained uncertain. By reviewing recent RCTs and MAs, the review supports that LR is physiologically and clinically better than NS. This review also highlights areas where current evidence remains limited and heterogeneous. Suggestions for future research include conducting a larger, multicenter randomized trial with standardized resuscitation protocols to ensure adequate statistical power. A more extensive trial is needed to establish a definitive conclusion, particularly for outcomes that have mixed or underpowered results in the available literature.