Evolution of early fluid therapy in acute pancreatitis: Balancing perfusion needs with fluid toxicity

Figure 1 Evolution of fluid-resuscitation strategies in acute pancreatitis. LR: Lactated Ringer’s solution.

Figure 2 Under-resuscitation sustains microcirculatory ischemia, whereas over-resuscitation worsens edema and organ dysfunction; the therapeutic goal is to preserve effective perfusion while limiting capillary leak.

Figure 3 Endothelial and glycocalyx injury as a mechanism linking inflammation, capillary leak, reduced effective circulating volume, and fluid-related harm in acute pancreatitis. LR: Lactated Ringer’s solution.

Figure 4 Organ-level consequences of under-resuscitation and over-resuscitation as well as a moderate, goal-directed approach to early fluid therapy in acute pancreatitis. MAP: Mean arterial pressure; UO: Urine output; BUN: Blood urea nitrogen; RESR: Respiratory tolerance.

Figure 5 Dynamic balance between perfusion need and fluid tolerance in acute pancreatitis, linking vascular leak to both benefit and harm during resuscitation.

Figure 6 Phenotype-aware bedside roadmap for fluid therapy in acute pancreatitis, integrating moderate Lactated Ringer’s-based resuscitation, repeated reassessment, and recognition of fluid responsiveness or intolerance. LR: Lactated ringer’s solution; MAP: Mean arterial pressure; AP: Acute pancreatitis; AI: Artificial intelligence.