ABSTRACT
Acute pancreatitis (AP) is the most common pancreatic disease. It is characterized by both local pancreatic and secondary system inammatory responses resulting from the premature activation of the proteolytic proenzymes such as trypsinogen within the pancreatic acinar cells. Mild disease, contributing to >80% of hospital admissions, is conned to the pancreas and usually resolves within a few days of bowel rest and analgesia. The remaining 20% develop the severe disease (SAP) with cytokine-driven systemic complications associated with an overwhelming systemic inammatory response syndrome and multiorgan failure (MOF). It is this group that contains all the morbidity and mortality, often resulting in prolonged intensive care unit (ICU) and hospital stay, and the need for surgery for pancreatic complications such as necrosis. SAP is one of the most catabolic of critical conditions encountered within the ICU, with high metabolic and nutritional requirements. Nutritional support is difcult because (a) enteral feeding may exacerbate the disease, (b) the inamed swollen pancreas and associated uid collections compress the upper gastrointestinal (GI) tract making feeding tube placement difcult, (c) total parenteral nutrition (TPN) rests the pancreas, but produces serious complications such as hyperglycemia and gut derived amplication of the inammatory response.
