Medical Management of Acute Pancreatitis: Intravenous Fluid, Nutrition and Antimicrobial Therapy

Acute pancreatitis is one of the most common diseases of the pancreas. Although the incidence of acute pancreatitis is increasing, the mortality is decreasing. In general, most of fatal cases occur within 2 weeks after admission due to multi-organ failure. Initial medical treatment of acute pancreatitis is important in order to improve the prognosis of the patients with acute pancreatitis. Essential treatment in this early period includes intravenous hydration, paint control, enteral nutrition, and antimicrobial therapy. Although aggressive intravenous hydration with lactated Ringer’s solution can improve mortality rates and decrease the development of systemic inflammatory response syndrome in the patients with acute pancreatitis, fluid overload can induce pulmonary edema, increase of the extra-pancreatic fluid collection, intra-abdominal compartment syndrome, sepsis, and increase of the mortality. Therefore, goal-directed therapy, utilizing various parameters to guide fluid administration, reduces the risk of persistent single or multiple organ system failure, infected pancreatic necrosis or mortality from acute pancreatitis. Initiation of early oral feeding is recommended, beginning within 24 hours for mild acute pancreatitis. Enteral nutritional support is favored over parental nutrition in severe acute pancreatitis. Recent guidelines do not support the use of prophylactic antibiotics to prevent infection in necrotizing acute pancreatitis and severe acute pancreatitis. Korean J Pancreas Biliary Tract 2019;24(1):17-20