Background/Objectives: Acute pancreatitis (AP) is an inflammatory condition with diverse origins, often resulting in significant morbidity and mortality due to systemic inflammatory response syndrome (SIRS) and multiorgan failure. Fluid resuscitation is pivotal in early management, and it is aimed at preventing hypovolemia-induced ischemia and necrosis. This review evaluates fluid therapy strategies in AP, including fluid types, resuscitation rates, and clinical outcomes. Methods: This systematic review was conducted in January 2025 using databases such as PubMed, Medline, and Google Scholar, focusing on studies published between 2010 and 2024. Search terms included “acute pancreatitis”, “fluid resuscitation”, and related keywords. Studies involving adults with AP were analyzed to compare the outcomes of crystalloid and colloid use, aggressive vs. moderate fluid resuscitation, and administration timings. The primary outcomes were mortality and severe complications, while secondary outcomes included organ failure, SIRS, and length of hospital stay. Results: Crystalloids, particularly Ringer’s lactate (RL), are superior to normal saline in reducing SIRS, organ failure, and intensive care unit stays without significantly affecting mortality rates. Colloids were associated with adverse events such as renal impairment and coagulopathy, limiting their use. Aggressive fluid resuscitation increased the risk of fluid overload, respiratory failure, and acute kidney injury, particularly in severe AP, while moderate hydration protocols achieved comparable clinical outcomes with fewer complications. Conclusions: Moderate fluid resuscitation using RL is recommended for managing AP, balancing efficacy with safety. Further research is needed to establish optimal endpoints and protocols for fluid therapy, ensuring improved patient outcomes while minimizing complications.

Background/Objectives: Alcoholic acute pancreatitis (AP) is a major cause of hospital admissions in Eastern Europe. However, data from secondary-care centers on the impact of the COVID-19 pandemic are limited. Methods: We retrospectively analyzed all adult AP admissions to a secondary-care hospital between March 2018 and March 2025. Cases were classified by etiology and grouped into pre-pandemic, pandemic, and post-pandemic periods. We compared demographic, clinical, severity, recurrence, outcome, resource use, and cost data between alcoholic and non-alcoholic AP. Results: Among 1096 patients (63.5% male; median age 55 years), alcohol was the leading etiology (40.1%), peaking during the pandemic. Alcoholic AP was more common in men, rural residents, and smokers, and less common in patients with obesity or diabetes. Recurrence was higher in alcoholic AP (21.8% vs. 15.9%; p = 0.015). Severe disease was more frequent in alcoholic than biliary AP (38.4% vs. 22.3%; p = 0.001). Overall mortality was 8.4%, declining after the pandemic (10.4% pre-pandemic vs. 6.5% post-pandemic). In multivariable Cox models, pleural effusion (HR 7.88; 95% CI 3.27–18.99) and age (HR 1.02; 95% CI 1.00–1.03) independently predicted mortality in the overall cohort. In alcoholic AP, pleural effusion was the only independent predictor (HR 13.19; 95% CI 2.48–70.08). In non-alcoholic AP, pleural effusion (HR 6.83; 95% CI 2.40–19.44) and signs of shock (HR 3.49; 95% CI 1.14–10.71) were independent predictors. Conclusions: Alcoholic AP was the most frequent etiology, with higher recurrence and severity than biliary AP, but alcoholic etiology itself did not predict mortality. Mortality drivers differed by etiology: pleural effusion in alcoholic AP, and pleural effusion plus signs of shock in non-alcoholic AP. ICU transfer was associated with death in descriptive analyses but was treated as a downstream mediator and not included in adjusted models.