ICU Nutrition — FRCA Final MCQ
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Correct answer: D — Commence nasogastric enteral nutrition now
The correct answer is D. Severe or moderately severe acute pancreatitis is an indication for enteral nutrition, which NICE recommends starting within 72 hours of presentation. This patient is therefore already overdue nutritional support. As the gastrointestinal tract is functional and there is no gastric outlet obstruction or gastric-feed intolerance, nasogastric feeding is the appropriate initial tube-feeding route. Nasojejunal feeding is generally reserved for patients who cannot tolerate gastric feeding or have upper gastrointestinal obstruction; it should not be delayed until day 7. Parenteral nutrition carries infective and metabolic risks and is reserved for contraindication, failure or inadequacy of enteral feeding. Bowel sounds are not required before starting enteral nutrition, and oral feeding is not feasible during invasive ventilation.
Reference: NICE. Pancreatitis: diagnosis and management (NG104), recommendations 1.2.5–1.2.7, updated 2020. https://www.nice.org.uk/guidance/ng104/chapter/Recommendations; BMJ Frontline Gastroenterology. Practical guide to the management of acute pancreatitis, Nutrition section, 2019. https://fg.bmj.com/content/10/3/292