Practice Based Learning: Management of acute pancreatitis

Lyndsi Paumen MD

 

 

 

 

Presented by Lyndsi Paumen MD (PGY1)

Traditional management of mild acute pancreatitis:

  • NPO (with IVFs, Jejunal feeds, or TPN) – “Rest the Pancreas”
    • Rationale: food in duodenum → cholecystokinin release → pancreatic enzyme secretion
    • Activation of proteolytic enzymes → autodigestion/tissue injury

Developments:

  • It has now been shown that while the pancreas is inflamed (during acute pancreatitis), there is reduced secretion of pancreatic juice/trypsin
  • There is increased gut permeability in the state of acute pancreatitis;
  • Using the gut for nutrition is beneficial for maintaining the mucosal barrier

Conclusions:

  • To manage mild acute pancreatitis:
    • allow pt to take PO as tolerated***
    • 1.5-2x maintenance fluids (D5 NS?) (plus pain control)
  • An order set would be helpful to standardize care

References:

Warndorf MG, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011 Aug;9(8):705-9.

Eckerwall GE, et al. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery–a randomized clinical study. Clin Nutr. 2007 Dec; 26(6):758-63.

Szabo FK, et al. Early enteral nutrition and aggressive fluid resuscitation are associated with improved clinical outcomes in acute pancreatitis. J Pediatr. 2015 Aug;167(2):397-402.e1.

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