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Recent randomized controlled trials have compared normal saline and lactated Ringer’s as an optimal fluid for resuscitation in AP [41,42]. These trials used surrogate markers of severity as end points and did not necessarily use more salient clinical outcomes such as mortality and organ failure. However, lactated Ringer’s solution appears to be more beneficial, resulting in fewer patients developing SIRS when compared with normal saline [42,43]. Although the data is still limited, current clinical guidelines (ACG, IAP/APA) recommend using Ringer’s lactate as the preferred intravenous fluid over normal saline [5,29,44]. The AGA technical review analyzed two studies using hydroxyethyl starch (HES) in AP and noted that multiorgan failure was significantly increased with administration of HES [28]. AGA clinical guidelines do not recommend using HES in AP [29].