Fluid Resuscitation in Acute Pancreatitis — Going over the WATERFALL

Acute pancreatitis, responsible for approximately 300,000 hospital admissions in the United States annually, is characterized by intense inflammation of the pancreas that leads to severe disease in approximately one third of affected patients.1 Because no proven pharmacologic therapy for acute pancreatitis exists, treatment is largely supportive.2 Intravenous fluid resuscitation is recommended as a fundamental component of initial supportive therapy in acute pancreatitis, owing largely to observations that untreated pancreatic hypoperfusion contributes to poor outcomes such as pancreatic necrosis and death.3 For the past three decades, multiple studies — but few randomized, controlled trials — have investigated the effects of crystalloid . . .