Fig. 2

Proposed algorithm for fluid resuscitation in severe acute pancreatitis. Hypovolemic shock is reversed with intravenous balanced crystalloids until Resuscitation goals are met. In the Optimization phase, a continuous infusion should be provided to meet ongoing fluid losses. A continuous Reassessment is required to assess further needs for fluids, guided by advanced hemodynamic monitoring systems, aiming to define the real fluid requirements while evaluating any signs of fluid overload. The Stabilization evolves over the following days. Here, fluids are needed only to replenish ongoing losses and the evacuation starts with spontaneous or induced evacuation when the acute insult resolves. IV Intravenous; MAP Mean arterial pressure; UO Urinary output; Ht Hematocrit; BUN Blood urea nitrogen; IAP Intra-abdominal pressure; CVP Central venous pressure; GIPS Global increased permeability syndrome