Acute pancreatitis is a disease with a wide variety of pathophysiologies, ranging from mild to severe condition. In about 80% to 90% of cases, acute pancreatitis presents as a mild inflammation with low morbidity and mortality, self-reversing to normal condition within 3-4 days. However, the natural course of severe pancreatitis progresses into SIRS and necrosis of the pancreas and its surrounding tissue. And infection of the necrotic tissue develops in sepsis and organ failures. Therefore, the initial management for acute pancreatitis would significantly contribute on the early prognosis. The first step includes not only diagnosis but also initial treatment according to etiological assessment and severity stratification. The summarization of initial management revealed as follows: monitorings of temperature, pulse rate, blood pressure, urine output volume, abdominal pain etc, and treatments of cardio-pulmonary care with sufficient fluid resuscitation, pain control, resting of pancreas etc. As the treatment of the initial management after initial onset, the significances of nasogastric tube drainage, prophylactic use of broadspectrum antibiotics, continuous infusion of protease inhibitors, use of H2 receptor antagonists, control by enteral nutrition and so on have been discussed. And also the indications of total parenteral nutrition, selective digestive decontamination and the efficacies of peritoneal lavage, continuous hemodiafiltration and continuous arterial infusion of protease inhibitor and antibiotics have been reviewed. For those events, the evidences were collected by a systemic search of MEDLINE and Japan Centra Revues Medicina. And then practical recommendations were also graded and introduced to provide a framework for clinitians to manage acute pancreatitis as a guideline. This paper described a part of those recommendations.