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 ( Figure 58-3 ). 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.