The use of human serum albumin in the management of acute pancreatitis; experimental and clinical observations.

Abstract

Summary In the dog, the level of circulating serum trypsin inhibitor (antifibrinolysin) and a substrate of trypsin (fibrinogen) have been used as indices to measure the activity of trypsin in the blood stream following acute pancreatitis. From these determinations it would appear that considerably less trypsin appears systemically following pancreatitis than is well tolerated by the dog. Using these indices, it appears that albumin now available does not inhibit trypsin in vivo in either dog or human. Albumin does not inhibit trypsin in vitro . Ten dogs treated with adequate albumin to maintain plasma volume survived surgically-induced pancreatitis; nine dogs receiving inadequate albumin had persistent blood volume deficiencies of 30 per cent or more and all died. Four out of five dogs receiving adequate Dextran to support blood volume survived pancreatitis; six untreated controls all died. Patients treated with 800 to 1200 cc. of albumin over four to six days showed restoration of plasma volume to normal; too few have yet been treated to evaluate the effect of albumin on the course of pancreatitis.