Early low-fat oral feeding starts within 24–48 h; give goal-directed lactated Ringer's (~1.5 mL/kg/h) over the first 12–24 h — aggressive fluids are harmful; skip prophylactic antibiotics; skip early CT — image only when the diagnosis is unclear or the patient is not improving at 48–72 h.
ERCP within 24 h for cholangitis; persistent duct obstruction also needs specialist ERCP assessment. Mild biliary pancreatitis: cholecystectomy during the index admission; defer in severe disease with collections.
Necrosis: intervene only for infection or symptomatic complications; if stable, defer ideally ≥4 wk, then step up (drain → minimally invasive → surgery). Deterioration may require earlier drainage.
Grade severity by organ failure rather than by a score: transient organ failure resolving within 48 hours and/or local/systemic complications without persistent organ failure is moderately severe, and organ failure persisting beyond 48 hours is severe disease that belongs in ICU.
Investigations
First tests: Serum lipase, Sodium, potassium, bicarbonate, urea and creatinine, Full blood count, Liver biochemistry, Abdominal ultrasound.
Only if indicated: Triglycerides, Ionized calcium, Contrast CT abdomen, MRCP / endoscopic ultrasound.
Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine.
Management pathways in this chapter
Acute Pancreatitis: The First 48 Hours
Necrotizing Pancreatitis and Its Local Complications
Locked
Each pathway step by step, with its decision points
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.