Critical Care and Shock

Nutrition in acute pancreatitis


The management of acute pancreatitis depends on the evaluation of its severity, mainly based on multiparameter scores such as Ranson score. Patients with mild or moderate acute pancreatitis are characterized by a spontaneous recovery and do not require enteral or parenteral nutrition. Patients with severe pancreatitis need a nutritional support. According to present data, enteral nutrition should be preferred to parenteral nutrition. Parenteral nutrition should be used in cases with prolonged ileus, when patient do not tolerate enteral nutrition and when enteral nutrition is not unable to satisfy nutritional requirements. Energy requirements vary between 25 and 35 kcal/kg/day. It is recommended to start with 15 to 20 kcal/kg/day in patients with multi-organ failure. Glucose supply should be 3 to 6 g/kg/day, if necessary associated with insulin in order to maintain blood concentrations <10 mmol/l. Fat is well tolerated in the absence of hypertriglyceridemia. As in other stress conditions, a fat supply representing 30% of non-protein energy has been recommended. Protein requirements have been estimated at 1.2-1.5 g/kg/day. Vitamins and trace-elements should be integrated to nutritional support during severe pancreatitis with special attention to vitamins A, C, E, zinc and selenium.

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