Dysregulation of glucose metabolism in enterally fed patients with acute pancreatitis

Introduction

Dysregulation of glucose metabolism is one of Ranson's criteria for prognostic scoring in acute pancreatitis. Aim of this study was to evaluate the impact of gastric and jejunal access of enteral nutrition on glucose metabolism in patients with mild and severe acute pancreatitis.

Patients and methods

Eighty-two non-diabetic patients admitted to a medical ward for acute pancreatitis entered the study. All patients were treated with total parenteral nutrition, and subsequently with total enteral nutrition administered into the jejunum. The jejunal tube was placed into the stomach at the end of the study period. Glycaemia was monitored 48 h after onset of acute pancreatitis (G1), on the last day of jejunal nutrition (G2) and on day 2 of gastric nutrition (G3).

Results

In patients with mild acute pancreatitis (n = 56), G1 was above the normal range in 10 patients (17.9%), G2 in 2 patients (3.6%), and G3 in 3 patients (5.4%).

In patients with severe acute pancreatitis (n = 26), G1 was above the normal range in 22 patients (84.6%), G2 in 5 patients (19.2%), G3 in 5 patients (19.2%). Secondary diabetes mellitus was present in 3 patients of this group (11.5%). No significant difference of serum insulin levels was found between both groups.

Conclusion

Dysregulation of glucose metabolism in mild acute pancreatitis is transient and usually does not require therapeutic intervention. Hyperglycaemia in severe acute pancreatitis is clinically relevant and manifestation of secondary diabetes mellitus is frequent. Type of enteral nutrition does not represent a significant impact on glucose metabolism.