What is the timing and route of enteral nutrition?
The timing and route of enteral nutrition are influenced by the presence of pain, vomiting, and the number of nasogastric aspirates. A recent meta-analysis showed that enteral nutrition started within 48 hours of admission significantly reduced mortality. Nasogastric (NG) tube insertion appears to be the best current initial approach to enteral feeding as nasojejunal (NJ) tube insertion often requires endoscopy or radiology expertise for insertion and may cause a delay to commence feeding. The third topic I am going to discuss is fluid therapy and the effects it has on acute pancreatitis. Early fluid resuscitation is recommended to balance fluid losses and to improve pancreatic microcirculation. The most common cause of death in the early stages of pancreatitis is shock therefore it is of crucial importance to recognize the signs early and give early treatment. Fluid management is the treatment option that is most likely to improve clinical outcomes. The type of fluid which should be used for initial resuscitation in acute pancreatitis is still a matter of debate in current practice. Crystalloids, colloids, albumin, and hypertonic saline have all been tried in either experimental or clinical studies.