Acute pancreatitis (AP) is a condition for which no specific treatment is currently available. Interventions such as early endoscopic sphincterotomy or prophylactic antibiotic therapy in severe cases have not demonstrated clear benefits in published meta-analyses. Consequently, both clinical practice guidelines and systematic reviews emphasize supportive care as the cornerstone of management, with particular focus on early and aggressive fluid resuscitation. This review aims to compile the most up-to-date evidence regarding severe acute pancreatitis, with an emphasis on accurate diagnosis and effective treatment strategies. Given the high incidence of this condition in emergency departments and its potential for significant morbidity and mortality, understanding optimal management approaches is essential to improve patient outcomes.