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In severe acute pancreatitis, early enteral nutrition (within 24–48 hours) improves outcomes compared with prolonged NPO or early PN. EN helps maintain gut integrity, reduces bacterial translocation, and lowers infectious complications and mortality. If gastric feeding is tolerated, nasogastric EN is acceptable; if not, a nasojejunal route bypasses the stomach and minimizes pancreatic stimulation. PN is reserved for cases where EN is contraindicated or not feasible after attempts to establish post-pyloric feeds. Delaying nutrition for 5–7 days in a catabolic, critically ill patient increases negative nitrogen balance and complications. When initiating EN, start at low rates and advance as tolerated; monitor for abdominal pain, rising intra-abdominal pressure, and feeding intolerance. Formulas are typically standard polymeric; elemental formulas are not universally required. Tight glycemic control, adequate analgesia, and aggressive fluid/electrolyte management complement nutrition therapy to optimize recovery.