The Application of Total nutrient Admixture System in Acute Pancreatitis

ABSTRACT

Total parenteral nutrition (TPN) can improve nutritional status and place the exocrine pancreas at rest in patients with acute pancreatitis. Based on this rationale, nutritional support for a patient with severe acute pancreatitis is currently a widely accepted practice. However, the use of a total nutrient admixture (TNA) system for patients with acute pancreatitis has been controversial because of the etiological association of hyperlipidemia with this disease. In order to evaluate the safety and efficacy of such lipid emulsion-based parenteral nutrition (a TNA system) for acute pancreatitis patients, we prospectively analyzed 37 cases (Ranson's criteria > 3) in which a TNA system had been administered for more than 2 weeks at Wallace Memorial Baptist Hospital from January 1994 to December 1995. We classified the 37 patients into 3 groups by the amount of lipids administered daily (Group I 75 gm lipid/day) and compared the nutritional indices (weight, albumin, transferrin, total lymphocyte count, and nitrogen balance) and the triglyceride, the amylase, and the lipase levels in each group at the onset of the TNA system and after 2 weeks. The results are summarized as follows 1) The TNA system had positive effect on maintaining and improving the nutritional indices in 28 (75.7%) of the 37 cases. 2) We could relate the causative effect of the lipids on the aggravation of pancreatitis to the administered amount of lipids by checking the triglyceride, the amylase, and the lipase 2-3 times a week. A simultaneous increase in the amylase, the lipase, and the triglyceride (> 300 mg/dl) was seen in 3 of the 8 cases in Group III. Hence, we think that the TNA system can be a safe and effective method for parenteral nutrition, even in acute pancreatitis, and that the lipid content of the TNA system should be less than 75 gm per day to prevent of disease aggravation.