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Acute Pancreatitis-Fluid Selection — ABIM Board MCQ

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ModerateGastroenterologyAcute Pancreatitis-Fluid SelectionABIM Board

A 45-year-old with acute pancreatitis is tachycardic and mildly volume depleted but has no heart or kidney failure. Which early fluid strategy is preferred?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Use moderate lactated Ringer hydration with early reassessment

The best answer is “Use moderate lactated Ringer hydration with early reassessment”. Lactated Ringer solution is preferred for early resuscitation, delivered moderately rather than indiscriminately and reassessed within hours using examination, vital signs, urine output, BUN and hematocrit. Unrestricted aggressive hydration increases fluid overload, especially after the early window. Dextrose water, routine albumin and delayed treatment do not restore intravascular volume appropriately.

Reference: ACG 2024 Acute Pancreatitis Guideline Highlights: https://webfiles.gi.org/links/journals/AJG-Clinical-Guidelines-Highlights-Acute-Pancreatitis-2024-FINAL.pdf