Artificial nutrition in acute pancreatitis

Metabolic consequences of acute pancreatitis include increased energy expenditure, reduced carbohydrate tolerance as well as a negative nitrogen balance due to Muscle proteolysis. with reduced plasma levels of amino acids such as glutamine. It is usually advised to fast a patient with acute pancreatitis, so as not to stimulate pancreatic secretions. In mild to moderate acute pancreatitis, there is no benefit of parenteral nutrition compared to fasting associated with glucose and vitamin infusion. In severe acute pancreatitis, however, prolonged fasting warrants the use of parenteral or enteral nutrition. The latter, when administered in the jejunum, covers energy needs without stimulating the pancreas. The clinical superiority of enteral nutrition over parenteral nutrition has not been clearly established in severe acute pancreatitis. However, there is a number of facts that favor the use of enteral nutrition, which maintains intestinal trophicity and barrier function. A few studies may suggest a better glycemic control as well as a reduction of infectious complications and multi-organ failures. In acute pancreatitis, artificial nutrition should provide proteins in the range of 1.2 to 1.5 g/kg per day and energy in the range of 30 to 35 kcal/kg per day, including 3 to 6 g/kg per day of carbohydrates and approximately 2 g/kg per day of lipids (in order, to obtain plasma triglycerides levels less than 12 mmol/L). Supplementing formulas with arginine, glutamine, nucleotides and n-3 fatty acids seems to improve nutritional, immune and inflammatory parameters in acutely stressed ICU patients. However, immune-enhancing diets have not been specifically studied in severe acute pancreatitis.. Jejunal administration of probiotics such as lactobacilli may be harmful and therefore is not recommended. (C) 2008 Publie par Elsevier Masson SAS.