Approach to nutritional support in patients with acute pancreatitis
- Pancreatitis can resemble other cases of stressed metabolism. If severe pancreatitis precludes the resumption of food intake beyond 4 to 5 days, consideration should be given to nutrition support.
- The route of feeding remains controversial; neither bowel and pancreatic rest nor nutritional support has been shown conclusively to alter the clinical course beyond improvement of the nutritional state.
- Several recent randomized trials suggest that distal (jejunal) enteral feeding may be tolerated as well as bowel rest and total parenteral nutrition (TPN), with fewer complications.
- The enteral route may be tried in the absence of GI dysfunction (e.g., ileus). Energy expenditure is variable, but most likely only 20% to 30% above basal. Use partial parenteral nutrition or TPN if the enteral approach fails.
- Experiments suggest that parenteral nutrition, including intravenous fat, elicits little significant pancreatic secretion; however, all patients with pancreatitis should be monitored to exclude severe hypertriglyceridemia.
