Quote from Smokey9283
This patient was NPO for for 3 days and now is advance as tolerated, so we thought that we should start him out with clear liquids and then move onto bland foods. The RN that was in charge of this patient said that it would be ok to give him regular sprite if he desired, but just as someone above had mentioned this concerned me because of the amount of sugar in pop and how affected the pancreas is.
Most patients with pancreatitis require less than 4 days of NPO. Similarly most patients without diabetes do not develop diabetes from the pancreatitis. It is more common in chronic pancreatitis especially those that develop pseudocysts in the tail.
You did avoid one of the most common problems with advancing diet in pancreatitis. The common surgical approach is to go CL >>> FL >>> regular diet. This is mostly for reasons of gut motility. However, if you consider that FL is CL plus things with a lot of fat in them such as ice cream, you can see what the problem is. I generally specify CL to bland low fat. This usually works better.
There is a lot of dissension about treating pancreatitis. Feeding the stomach vs. Feeding in the jejunum. I think that most people are convinced that enteral feeding is better than TPN but you still see some pancreatitis patients on TPN.
Even sugary meals is somewhat controversial. There is a school of thought that says you do not need to be NPO just avoid fat. This school says that carbohydrate rich meals (ie Sprite) are OK even with severe pancreatitis. There is some evidence that any food provokes amylase and lipase production and may worsen pancreatitis but its pretty weak.
I was taught to keep the patient NPO until the patient clinically resolves (in adults when they are hungry is the best indication in my opinion). Then CL and advance to bland low fat. You will still find some people that are bothered by sugary meals in any case. My advice then is to avoid things that bother them.
David Carpenter, PA-C