title: Clinical update on fluid therapy and nutritional support in acute pancreatitis.
abstract: OBJECTIVE
  The aim of this focused review is to provide a valuable and updated source of information for clinical practice on fluid therapy (FT) and nutritional support in acute pancreatitis (AP).
  
  
  METHODS
  The review encompasses important new clinical information that has become available for understanding and offering these specific treatments since the 2013 publication of two guidelines, both the joint International Association of Pancreatology and American Pancreatic Association and the American College of Gastroenterology. The 2015 Revised Japanese Guideline is discussed selectively. To this end, the review is divided into 7 sections, including timing and cause of mortality; severity classification systems; predicting severity; response to treatment; nutritional support; fluid therapy and steps for further research.
  
  
  CONCLUSIONS
  In mild AP, begin oral feeding when nausea, vomiting and abdominal pain are improving. In (predicted) severe AP, feeding decisions should commence by 72 h, offering oral feeding if GI symptoms improve or enteral feeding if patients are symptomatic and/or intolerant to orals. All patients should be offered goal-directed FT during the first 6-12 h of presentation. Cautious FT is advised in those age >55 years or with preexisting organ failure or predictors of developing fluid sequestration.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, The University of Michigan School of Medicine, 1150 W. Medical Center Drive, 6520 MSRB 1, Ann Arbor, MI 48109-0682, USA. Electronic address: mdimagno@umich.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: DiMagno
mesh_terms: D005440:Fluid Therapy; D006801:Humans; D018529:Nutritional Support; D010195:Pancreatitis / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Acute pancreatitis; Clinical update; Fluid sequestration; Fluid therapy; Mortality; Nutritional support