Acute pancreatitis

Acute pancreatitis

1. Acute inflammatory process that involves peripancreatic tissue and other organs

   • hypercatabolic state
     • nitrogen losses 20-40g/day
   • starvation
   • gut bacterial and inflammatory mediators translocation

2. Causes

   • alcoholism and ¿Lithiasis?
   • hypertrigliceridemia
   • meds
   • trauma
   • autoimmune diseases

3. Nutritional risk

   • Malnutrition
     • pancreatic necrosis

4. Assessment

   • APACHE
   • Full nutritional assessment
   • Subjective Global Assessment

5. Diagnosis

   • APACHE
   • Ransons criteria
   • Anatomical classification
   • Nutritional assessment
   • Disease control

6. Nutritional support

   • Mild to moderate
     • Step 1(2-5 days)
       • fasting
       • iv fluid and electrolyte replacement
         • 25-500ml/hr Ringers lactate
       • treat the cause
       • analgesia
     • Step 2 (3-7 days)
       • refeed with
         • lots of carbohydrates
         • moderate in protein if no pain
         • moderate in fat if enzymes decrease
     • Step 3
       • normal diet
   • Energy: 25-35kcal/kg/day
   • Protein: 1.2-1.5g/kg/day
   • carbohydrates: 3-6g/kg day
     • check blood glucose
   • Lipids: 2g/kg/day
     • check blood trygliceride concentration
   • Start oral diet when tolerate
     • inadequate intake?
       • start enteral nutriton support (nasoduodenal tube and polymeric formula)