Case Presentation

A 47 year old male with a known case of acute pancreatitis cameto the emergency ward of the hospital with clinical features presentingepigastric pain, giddiness and nausea. The laboratory results revealedhence a relapse of acute pancreatitis was diagnosed. The patient wasimmediately put on treatment by the doctor after screening patient’shealth status and clinical severity of the disease. The dieticianperformed a detailed assessment of his dietary intake by taking 24-hour recall studying his food pattern, habits, likes and dislikes whichhelped in understanding his overall nutritional status of poor lifestyle,erratic meal pattern and high consumptions of zero calorie foods. Theanthropometry measurements revealed abdominal adiposity with a waist circumference of 111cms and body mass index were 29kg/m²of pre-obese stage, a population based study revealed an increaserisk for acute pancreatitis with an increased body mass index status(10) and a 2 fold increase in risk of acute pancreatitis with waistcircumference of > 105cm (14). The relapse of his third attack was dueto chronic alcoholism and poor lifestyle with other complications. Toavoid stimulation of the pancreas, he was nil by mouth (NBM) for3 tube) was inserted for initiating feeds to balance the nutritionalneeds. Oral feeds were initiated on absence of abdominal pain,tenderness, absence of other complications, reduction in levels ofCRP and pancreatic enzymes. NJ-tube feeds of clear liquids wereinitiated on the 4th day 30cc/hourly which was well tolerated henceon the following 5th day 60cc/hourly of full liquids was given, 6thday with 70cc/hourly of full liquids, 7th day with 150cc/ 3 hours offull liquids + 2hourly Oral liquids, 8th day with 200cc/ 3 hours of fullliquids + 2hourly Oral liquids. On the 9th day soft diet was given tothe patient on seeing the improvement in tolerance level. The patientshowed quick improvements and hence was discharged on the 10thday with medical and nutritional support. Overall nutritional statuswas taken care by following a systemic approach a suitable diet wasplanned which helped in early recovery of the patient with an overallimprovement in moderate protein, starting with 1 tsp of fat (coconutoil or ghee), small portion frequent meals, early dinner. A populationstudies reported the largest increase in incidence of acute pancreatitiscompared to chronic (2). One such independent risk factor leadingin increasing the risk factors of pancreatitis is alcohol. In an Indian study, nationwide prospective survey of chronic pancreatitisconcluded that idiopathic pancreatitis was the most common form,followed by alcoholic pancreatitis in India. Alcoholism is the mostcommon cause of chronic pancreatitis worldwide (12). Autodigestionof the pancreas is seen due to the toxic effect of alcohol (13). Ourcase presented similar observations of pancreatitis induced by chronic alcoholism and the relapse clearly states the involvementof alcohol and no improvement in lifestyle. An improved healthstatus of the patient was noted after one month follow up and anormal nutritionally balanced diet comprising approximately 1800 to2000kcal was followed by the patient.