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Acute Pancreatitis — RACP Adult Medicine MCQ

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EasyGeneral Internal MedicineAcute PancreatitisRACP Adult Medicine

A 50-year-old man presents with acute severe epigastric pain radiating to the back. Serum lipase is 1200 U/L (>3× ULN). He has a history of heavy alcohol use. An abdominal ultrasound shows no gallstones. Within the first 24 hours, which of the following is most important in management?

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Correct answer: B — Aggressive IV fluid resuscitation with Ringer's lactate

Aggressive early IV fluid resuscitation (preferably with Ringer's lactate at 5–10 mL/kg/hr for the first 24 hours, adjusted to clinical response) is the cornerstone of early management of acute pancreatitis. It reduces the risk of pancreatic necrosis and organ failure. Prophylactic antibiotics are NOT recommended. CT is not indicated within the first 72 hours unless there is diagnostic uncertainty or clinical deterioration. Early oral feeding (within 24 hours if tolerated) is now recommended over prolonged NBM.

Reference: eTG – 2025 – Gastrointestinal; IAP/APA – 2024 – Acute Pancreatitis Guidelines