Question
A 45-year-old male presents to the emergency department with severe abdominal pain radiating to the back. Laboratory investigations reveal elevated serum amylase and lipase levels. Which of the following should be avoided in the management of the given condition?
| A. |
Nil per oral to avoid pancreatic stimulation
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| B. |
Administration of 5% dextrose
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| C. |
Parenteral nutrition is preferred for 2-3 days over the nil per oral (NPO) approach
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| D. |
Early initiation of oral feedings
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Show Answer
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Correct Answer » C
Explanation
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|
- The patient has acute pancreatitis, suggested by:
- Severe epigastric pain radiating to the back.
- Elevated serum amylase and lipase.
- Initial management focuses on:
- Aggressive intravenous fluid resuscitation.
- Adequate analgesia.
- Correction of electrolyte abnormalities.
- Early nutritional support.
- Routine parenteral nutrition should be avoided in acute pancreatitis.
- Current guidelines recommend early enteral nutrition (oral or tube feeding) whenever feasible.
- Enteral feeding:
- Maintains gut mucosal integrity.
- Reduces bacterial translocation.
- Decreases infectious complications.
- Lowers mortality compared with parenteral nutrition.
- Parenteral nutrition is reserved only for patients in whom enteral feeding is impossible or contraindicated.
- Therefore, routine preference for parenteral nutrition during the first 2–3 days is incorrect and should be avoided.
Why Other Options are Correct
A. Nil per oral (NPO) initially to minimize pancreatic stimulation
- Traditionally, patients were kept NPO during the acute phase.
- Although prolonged fasting is no longer recommended, temporary NPO may be appropriate in patients with severe pain, persistent vomiting, or ileus until oral intake is tolerated.
B. Administration of 5% dextrose as part of intravenous fluid therapy when indicated
- Intravenous fluids are essential in acute pancreatitis.
- Lactated Ringer’s solution is generally preferred for resuscitation.
- Dextrose-containing fluids may be used when clinically indicated, such as to prevent hypoglycemia or provide maintenance fluids.
- Therefore, this is not a practice that should routinely be avoided.
D. Early initiation of oral feeding once abdominal pain improves and nausea or vomiting has resolved
- Early oral feeding is recommended.
- Patients with mild acute pancreatitis should resume oral feeding as soon as tolerated.
- Early feeding shortens hospital stay and reduces complications.
