A 55-year-old man (weight 70 kg) with well-controlled hypertension and type 2 diabetes mellitus (no history of congestive heart failure or chronic kidney disease) presents to the emergency department with 12 hours of severe epigastric pain radiating to his back, accompanied by nausea and vomiting. His vital signs are: heart rate 115 beats/min, blood pressure 105/65 mmHg, respiratory rate 22 breaths/min, and oxygen saturation 98% on room air. Laboratory evaluation reveals a serum lipase of 2,500 U/L. A diagnosis of acute pancreatitis is made. Based on current evidence regarding fluid management in acute pancreatitis, which of the following is the most appropriate initial intervention?

A 58-year-old man presents with a 2-day history of severe, constant epigastric pain radiating to the back, accompanied by nausea and vomiting. He has a history of chronic alcohol use. Laboratory evaluation reveals serum amylase 850 U/L (reference 25–125 U/L) and serum lipase 1500 U/L (reference 10–140 U/L). Which of the following combinations MOST strongly supports the initial diagnosis of acute pancreatitis?

A 45-year-old man (weight 80 kg) is admitted to the critical care unit with severe epigastric pain radiating to his back, nausea, and vomiting. On arrival his temperature is 38.5 °C, blood pressure 85/50 mmHg, heart rate 120 bpm, respiratory rate 28/min, and oxygen saturation 88% on room air. He is intubated for acute respiratory distress syndrome and requires a continuous norepinephrine infusion at 0.1 mcg/kg/min via a central venous catheter to maintain mean arterial pressure above 65 mmHg. Initial laboratory results show a serum lipase of 1200 U/L (reference range 10–140 U/L) and a white blood cell count of 18,500/mm³. A contrast-enhanced CT scan of the abdomen on admission reveals diffuse pancreatic edema and peripancreatic fluid collections without necrosis. By hospital day 4, he remains intubated on vasopressors and his creatinine has risen to 2.5 mg/dL (baseline 0.9 mg/dL). Based on the Revised Atlanta Classification, which of the following severity classifications best describes this patient’s condition?

A 62-year-old man is admitted to the ICU with severe epigastric pain radiating to his back, nausea, and vomiting. Initial labs reveal a lipase of 1200 U/L (reference 10–140 U/L). On admission, he is tachycardic (HR 115 bpm), tachypneic (RR 24 breaths/min), and has a WBC of 18,000/mm³. His blood pressure is 85/50 mmHg, which improves to 110/70 mmHg after a 2 L bolus of lactated Ringer’s solution. Over the next 48 hours, he develops hypoxemic respiratory failure requiring mechanical ventilation and acute kidney injury requiring continuous norepinephrine to maintain MAP >65 mmHg. These organ failures persist beyond 48 hours. Imaging on day 5 shows peripancreatic fluid collections without necrosis. According to the Revised Atlanta Classification (2012), which of the following BEST describes his acute pancreatitis severity and the primary factor driving this classification?

A 45-year-old woman (weight 70 kg) presents to the emergency department with a 12-hour history of severe epigastric pain radiating to the back, accompanied by nausea. Her triage vital signs are: heart rate 115 bpm, blood pressure 105/65 mmHg, and respiratory rate 22/min. Initial labs show a lipase of 3,500 U/L and a blood urea nitrogen (BUN) of 25 mg/dL. She appears clinically dehydrated without signs of organ failure. Which fluid resuscitation strategy is most appropriate for the initial management of this patient?

A 62-year-old man was admitted 10 days ago with acute pancreatitis. He initially presented with severe epigastric pain, elevated lipase, and systemic inflammatory response syndrome. Over the past week, he developed acute kidney injury requiring continuous renal replacement therapy for 3 days, and his respiratory status worsened, necessitating FiO₂ 80% and PEEP 12 cmH₂O on mechanical ventilation. CT imaging now shows a large peripancreatic fluid collection and pancreatic necrosis. He remains hypotensive at 85/50 mmHg despite norepinephrine 0.2 mcg/kg/min, and his creatinine is 3.5 mg/dL (baseline 0.9). According to the 2012 Revised Atlanta Classification (Consensus Guideline), how should his acute pancreatitis severity be classified?

A 45-year-old man is admitted to the intensive care unit with severe acute pancreatitis. He is intubated, maintained on assist-control ventilation, and has a central venous catheter in place for vasopressor support. He weighs 75 kg. Upon admission, he received aggressive intravenous fluid resuscitation. Over the past 12 hours, his intra-abdominal pressure (IAP) has trended upward from 12 mmHg to 18 mmHg, and he has developed new-onset oliguria. His Sequential Organ Failure Assessment (SOFA) score has increased to 7. Given this patient’s clinical evolution, which of the following is the most appropriate adjustment to the fluid management plan?

A 48-year-old man is admitted to the critical care unit for severe acute pancreatitis. He is on assist-control ventilation for acute respiratory distress syndrome (ARDS) and requires a continuous norepinephrine infusion at 0.1 mcg/kg/min via a central line to maintain a mean arterial pressure (MAP) > 65 mmHg. His initial presentation 10 hours ago included severe epigastric pain, nausea, and vomiting. Labs on admission showed lipase 2500 U/L, WBC 18,000/mm³, BUN 30 mg/dL, and creatinine 1.5 mg/dL (baseline 1.2 mg/dL). He has received 3 L of lactated Ringer’s solution over the past 10 hours. Current vitals: HR 110 bpm, BP 90/60 mmHg (MAP 70 mmHg with pressor), RR 28 bpm, SpO2 92% on FiO2 0.6. Urine output over the last 2 hours is 0.3 mL/kg/hr. He has a history of hypertension and chronic kidney disease. Considering his ongoing organ dysfunction and comorbidities, which of the following fluid resuscitation strategies is MOST appropriate to prioritize at this time?

A 58-year-old woman is admitted from the emergency department with acute pancreatitis. On arrival to the telemetry unit, her vital signs are: temperature 37.8 °C, heart rate 115 bpm, blood pressure 105/65 mmHg, and respiratory rate 22 breaths/min. She appears uncomfortable and dehydrated. Laboratory results show lipase 3,500 U/L, creatinine 1.2 mg/dL (baseline 0.8 mg/dL), and BUN 28 mg/dL. An initial CT scan demonstrates interstitial edematous pancreatitis. She weighs 70 kg. Which of the following initial fluid resuscitation strategies is most appropriate?

A 45-year-old man is admitted to the medical intensive care unit with severe acute pancreatitis. He is intubated on assist-control ventilation and requires a continuous norepinephrine infusion via a central line to maintain mean arterial pressure. Over the past 12 hours, after receiving 6 liters of intravenous lactated Ringer’s solution, his oxygen saturation has dropped from 98% to 90% on an FiO2 of 0.6. He has developed new bilateral crackles on lung auscultation, his central venous pressure (CVP) has increased from 8 mmHg to 16 mmHg, and a chest X-ray shows new diffuse bilateral infiltrates consistent with pulmonary edema. Given the patient’s current clinical status, which of the following is the MOST appropriate immediate intervention?