Hypertriglyceridemia with total parenteral nutrition versus enteral nutrition in patients with acute pancreatitis

Abstract Background Acute pancreatitis (AP) is an inflammatory condition of the pancreas that can cause local injury, systemic inflammatory response syndrome, and organ failure. Worldwide, AP is a common gastrointestinal condition and there is evidence that the incidence has been rising in recent years. AP is associated with substantial suffering, morbidity, and cost to the health care system. Objective Our study aims to compare between the effect of enteral (EN) and parenteral nutrition on serum triglycerides in patient with acute pancreatitis in intensive care unit of Ain Shams University (ICU). We found that enteral route is more safe than parenteral nutrition regarding serum triglycerides. Patients and Methods An informed written consent was obtained from patients and /or relatives who were included in this study. All patients were adults, more than 18 years old, admitted to ICU of Ain Shams University Hospital, either have acute pancreatitis on admission or acquired acute pancreatitis in ICU due to different causes in period of six months of approval of the protocol. Patients were divided into two groups: 30 patients started total parenteral nutrition TPN ) one day after admission consisting of 70% carbohydrate (in the form of dextrose 25%) and 30% fat (smoflipid 250 ml, 2 gm per ml). The other 30 patients started enteral nutrition rich in carbohydrates with low fat content one day after admission (peptamen) 6 scoops in 200 ml water every 2 hours, stopped from 12 am to 8 am. Serum triglyceride level was measured at first day of admission, then 3 days after admission, then one week after admission. Results Our study showed that TPN was associated with more increase of serum triglycerides level from first day of admission to 3 days after admission when compared with enteral nutrition, there is also increase in serum triglycerides from 3days to one week after admission, comparing the three periods together, there is increase in serum triglycerides with TPN group more than in enteral group. Conclusion The study showed that TPN was associated with higher mortality rate than EN, also there was an increase in serum triglycerides with TPN more than EN; suggesting that, enteral nutrition is a safer mode of nutrition in patients with acute pancreatitis.