Parenteral nutrition 투여와 pancreatic enzyme 상관 관계

[1] Intravenous versus intraduodenal amino acids, fats and glucose as stimulants of pancreatic secretion

 

canine exocrine pancreas에 amino acid & lipid & glucose를 각각 intraduodenal vs. intravenous 투여

limtation : animal study

투여 방식에 따른 췌장 효소 분비	pancreatic secretion of volume
intraduodenal	(+)
intravenous	(-)

As a corollary, it is reasonable to assume that the pancreas is not stimulated during total parenteral nutrition with acute pancreatitis or a pancreatic fistula.

 

[2] Effect of intravenous lipid on human pancreatic secretion

 

6명의 건강한 성인 지원자에게 parenteral lipid 투여 후 double lumen tube으로 흡인된 enzyme과 bicarbonate를 측정함

• DAY1 : Intralipid(5, 10, 20%) 농도 별 1시간 동안 IV infusion + with secretin
• DAY2 : Intralipid(5, 10, 20%) 농도 별 1시간 동안 IV infusion + without secretin
• DAY3 : Intralipid(5, 10, 20%;IV 투여 시와 동량) 장관 내 투여
• DAY4 : 20% Intralipid 장관 내 2시간 동안 투여 & 10% Intralipid IV (=20% Intralipid was given by intestinal infusion for 2 h while 10% Intralipid was infused intravenously during the second hour)

 

Significant stimulation of enzyme secretion was observed only during the infusion of fat into the intestine, not after intravenous infusion at any concentration. Pancreatic enzyme secretion, stimulated by intraintestinal fat, was not significantly modified by simultaneous intravenous lipid infusion. We conclude that since intravenous fat does not stimulate pancreatic secretion, its use in conditions where pancreatic stimulation is undesirable appears safe.

 

결론

Amino acids	Parenteral amino acid infusion does not affect pancreatic secretion or function
Carbohydrates	Parenteral carbohydrate infusion does not affect pancreatic secretion and function
Lipids	Lipid emulsions do not affect pancreatic secretion.

정맥으로 투여되는 영양분은 amylase/lipase와 같은 췌장 효소 분비에 영향을 주지 않음

 

reference :

(1) Stabile, B. E., and H. T. Debas. "INTRAVENOUS VERSUS INTRA-DUODENAL AMINO-ACIDS, FATS, AND GLUCOSE AS STIMULANTS OF PANCREATIC-SECRETION." SURGICAL FORUM. Vol. 32. 54 EAST ERIE ST, CHICAGO, IL 60611: AMER COLL SURGEONS, 1981.

(2) Edelman, Kalman, and Jorge E. Valenzuela. "Effect of intravenous lipid on human pancreatic secretion." Gastroenterology 85.5 (1983): 1063-1066.

(3) Gianotti, L., et al. "ESPEN guidelines on parenteral nutrition: pancreas." Clinical Nutrition 28.4 (2009): 428-435.