Early aggressive fluid resuscitation in acute pancreatitis improves microcirculation and prevents hypovolemia-induced pancreatic ischemia, reducing the risk of systemic inflammatory response and multiorgan failure, which are major causes of mortality. Adequate hydration within the first 24 hours lowers rates of necrosis and infection. In contrast, early antibiotics, immediate surgery, and total parenteral nutrition have not consistently demonstrated mortality benefits and may carry risks such as antibiotic resistance or surgical complications. Thus, optimizing intravascular volume status is the cornerstone of reducing early mortality in acute pancreatitis.

Reference: Harrison's Principles of Internal Medicine, 21st Edition.