Abstract: Acute pancreatitis is an inflammatory entity involving the pancreas and peri-pancreatic tissues. Severe acute pancreatitis leads to persistent organ failure and high mortality. Treatment in the first 24 hours of admission is crucial for the prognosis. Current evidence indicates that adequate fluid resuscitation with lactated Ringer's and early enteral nutrition may be effective, but prophylactic antibiotics and early ERCP should not be routinely used. The small sample size is a major limitation for current research. Large scale, multi-center randomized controlled trials are eagerly awaited.