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Nutritional support in acute pancreatitis.
Gastroenterol Clin North Am. 1989 Sep; 18(3):525-42.GC

Abstract

Acute pancreatitis often results in a hyperdynamic, consumptive state. Hallmarks of this condition are decreased peripheral resistance with increased cardiac output. Hemodynamic and cardiovascular changes are accompanied by metabolic alterations. Increased protein catabolism, increased ureagenesis, glucose intolerance, increased lipolysis, and reduced servoregulation are metabolic changes commonly seen in this syndrome. To preserve organ structure and function, biochemical processes must be metabolically supported. Substrate needs change as stress level increases. The per cent of total calories provided as protein must increase. Branched-chain-enriched amino acid solutions have been shown to improve nitrogen utilization in hypermetabolic patients and may therefore be beneficial for the patient with acute pancreatitis. Glucose utilization decreases and free fatty oxidation increases. A mixed fuel system that provides fat, protein, and glucose is suggested for these patients. IV fat has been shown to be a safe energy substrate for patients with pancreatitis in the absence of hyperlipidemia. Failure to use fat as an energy substrate in conjunction with TPN may result in hepatic steatosis and excess carbon dioxide production. The decision of whether to use the parenteral or enteral route to nutritionally support the patient with pancreatitis remains controversial. TPN may allow maintenance of pancreatic rest. The role of enteral feedings is less clear. However, it has been shown that the further down the alimentary tract the feeding is infused, the less pancreatic stimulation occurs. Therefore, it seems wise to support the patient with TPN during severe acute pancreatitis. Jejunal enteral feedings should be initiated as a transitional feeding when the acute inflammatory episode begins to subside.

Authors+Show Affiliations

Master's Program in Nutrition Support Dietetics, University of Minnesota, Minneapolis.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

2509354

Citation

Havala, T, et al. "Nutritional Support in Acute Pancreatitis." Gastroenterology Clinics of North America, vol. 18, no. 3, 1989, pp. 525-42.
Havala T, Shronts E, Cerra F. Nutritional support in acute pancreatitis. Gastroenterol Clin North Am. 1989;18(3):525-42.
Havala, T., Shronts, E., & Cerra, F. (1989). Nutritional support in acute pancreatitis. Gastroenterology Clinics of North America, 18(3), 525-42.
Havala T, Shronts E, Cerra F. Nutritional Support in Acute Pancreatitis. Gastroenterol Clin North Am. 1989;18(3):525-42. PubMed PMID: 2509354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutritional support in acute pancreatitis. AU - Havala,T, AU - Shronts,E, AU - Cerra,F, PY - 1989/9/1/pubmed PY - 1989/9/1/medline PY - 1989/9/1/entrez SP - 525 EP - 42 JF - Gastroenterology clinics of North America JO - Gastroenterol Clin North Am VL - 18 IS - 3 N2 - Acute pancreatitis often results in a hyperdynamic, consumptive state. Hallmarks of this condition are decreased peripheral resistance with increased cardiac output. Hemodynamic and cardiovascular changes are accompanied by metabolic alterations. Increased protein catabolism, increased ureagenesis, glucose intolerance, increased lipolysis, and reduced servoregulation are metabolic changes commonly seen in this syndrome. To preserve organ structure and function, biochemical processes must be metabolically supported. Substrate needs change as stress level increases. The per cent of total calories provided as protein must increase. Branched-chain-enriched amino acid solutions have been shown to improve nitrogen utilization in hypermetabolic patients and may therefore be beneficial for the patient with acute pancreatitis. Glucose utilization decreases and free fatty oxidation increases. A mixed fuel system that provides fat, protein, and glucose is suggested for these patients. IV fat has been shown to be a safe energy substrate for patients with pancreatitis in the absence of hyperlipidemia. Failure to use fat as an energy substrate in conjunction with TPN may result in hepatic steatosis and excess carbon dioxide production. The decision of whether to use the parenteral or enteral route to nutritionally support the patient with pancreatitis remains controversial. TPN may allow maintenance of pancreatic rest. The role of enteral feedings is less clear. However, it has been shown that the further down the alimentary tract the feeding is infused, the less pancreatic stimulation occurs. Therefore, it seems wise to support the patient with TPN during severe acute pancreatitis. Jejunal enteral feedings should be initiated as a transitional feeding when the acute inflammatory episode begins to subside. SN - 0889-8553 UR - https://www.unboundmedicine.com/medline/citation/2509354/Nutritional_support_in_acute_pancreatitis_ L2 - https://www.diseaseinfosearch.org/result/9663 DB - PRIME DP - Unbound Medicine ER -