Evolution of early fluid therapy in acute pancreatitis: Balancing perfusion needs with fluid toxicity

Table 4 High-risk clinical phenotypes and practical implications for fluid strategy in acute pancreatitis

Phenotype	Why risk is higher	Practical implication	Ref.
Severe AP with evolving organ failure	Inflammation may uncouple fluid load from effective perfusion	Reassess frequently	[34,36,53]
Hypertriglyceridemia-associated AP	Distinct metabolic drivers may alter fluid tolerance	Avoid a generic algorithm	[37-39]
Obesity and reduced thoracic reserve	Positive balance may trigger respiratory compromise	Use smaller test boluses
Cardiorenal or unstable high-risk presentations	Fluid tolerance may be low and organ-support needs may evolve rapidly	Escalate support earlier	[54,55,57,58]

AP: Acute pancreatitis.