RESUMO
Metabolic changes that occur in acute pancreatitis result, as with other critically ill patients, in a metabolic stress situation that many times requires the application of a specialized nutritional support. Patients presenting the highest severity indexes (defined as Ranson's index = 3 or an APACHE II = 10) are candidates to receive nutritional support. Enteral nutrition must be the first route to consider for nutrients supply and must be maintained except for patients that have intolerance or develop pain, ascites, or increased serum amylase levels. Transpyloric enteral nutrition, through a naso-jejunal tube or by means of a jejunostomy catheter, is a safe access in severe acute pancreatitis, and it may even be accompanied by advantages in the patients' clinical course as compared with parenteral nutrition. The indication for parenteral nutrition would be conditioned by the inability to obtain an appropriate enteral (jejunal) approach, intolerance to enteral nutrition, or disease exacerbation after the onset of enteral nutrition support. With current data, no recommendations can be established in relation to the ideal characteristics that nutrients composition received by acute pancreatitis patients should meet.