<prompt> A 35 year old man presents with Acute Pancreatitis. The ideal fluid of choice in the initial management isIsotonic crystalloidHypertonicHypotonicVasopressin  <response>: A Isotonic crystalloid?INITIAL MANAGEMENT:oCrystalloids: Ringers lactate or Normal saline.oWhile crystalloids appear to be the Ideal Choice based on expert opinion the guidelinesrecommendations from America, Italy Japan.oThese recommendations are not based on high - level evidence in patients with acute pancreatitis.ADVANTAGES DISADVANTAGES OF DIFFERENT FLUID TYPES IN RESUSCITATIONFluid TypeAdvantagesDisadvantagesIsotonic crystalloids lactated Ringers solution, 0.9 sodium chloride, Normosol-R, Plasmalyte A. Los cost. Necessary in dehydration. Widely available. Large volumes needed. Longer time to resuscitate. Require more technical staff E.g., Placement of multiple, large-guage IV catheters. Risk of hypothermia. Risk of interstitial edema. Risk of hemodilution. Risk of re-bleedingHypertonic saline. Low cost. Small volumes needed for rapid resuscitation. Minimizes risks of interstitial edema. Beneficial neurological effects; decreases intracranial pressure. Immunomodulatory effects. Beneficial cardiac effects. Short acting when used alone. Transient hypernatremia. Hypotension, bronchoconstricction, or arrhythmias with rapid administration. Risk of volume overload. Possible phlebitis. HyperosmolarSynthetic colloids 6 hetastarch, 10 pentastarch, 6 dextran 70. Smaller volumes needed for rapid resuscitation compared with crystalloids. Minimizes risks of interstitial edema. Longer duration of effect. Increases COP. Less hemodilution. Higher cost. Risk of volume overload. Exacerbation of coagulopathies. Risk of allergic reactions. Edema with vasculitis. Interference with cross-matchingHemoglobin-based oxygencarrier Oxyglobin. Increases COP. Increases oxygen delivery. Eliminates need to cross-match. 2 year shelf life. Higher cost. Risk of volume overload. Possible risk of anaphylaxis with multiple uses. Inability to measure certain blood values after useoAggressive hydration, defined as 250-500 per hour of isotonic crystalloid solution should be provided to all patients, unless cardiovascular, renal or other related co-morbid factors exist.oEarly aggressive intravenous hydration is most beneficial during the first 12-24 hr, and may have little benefit beyond this time period.oIn a patient with severe volume depletion, manifest as hypotension tachycardia, more rapid repletion bolus may be needed. 