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
- 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
- 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
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.