Changing strategy in necrotizing pancreatitis with hyperalimentation

F25CHANGING STRATEGY IN NECROTIZING PANCREATITIS WITH HYPERALIMENTATION: J.L.Gouzi, B.Pradere, Y.Parent. M.Costecalde, C.H.U. Purp;n. Toulouse, rrance: e aim of the study is to compare the results of treatment of severe necrotizing pancreatitis with and without hyperalimentation. 36 patients with acute necrotizing pancreatitis were selected for a retrospective analysis between 1972-1982. The severity of pancreatitis was assessed by an average of 4 Ranson's criteria per patient and by extensive pancreatic or peripancreatic necrosis at operation. 12 patients did not receive any nutrition. 24 patients received hyperalimentation by parenteral and/or enteral route; mean duration: 45 days; mean caloric intake: 42 Kcal/kg/day. 16 patients were operated on before the 10th day, 20 patients after the 21st day. IO patients had pancreatectomy, 26 had drainage or sequestrectomy. Nb. of Cases

Results Without nutrition With nutrition

I

12 24

Deaths

I

12 5

Early operation Delayed operation

16 20

12 5

Radical surgery Conservative surgery

10 26

9 8

It is concluded that hyperalimentation allows delayed surgery for necrotizing pancreatitis, with limited conservative procedures and a better prognosis.

F26BODY WATER FLUX IN PREMATURES. F.Haschke, G.Simbrunner. Dept.of Pediatrics and Div. Neonatology, Dept.Ped., Univ.of Vienna, Austria. Water flux rate measurement in growing animals allows estimation of water intake, gain in body water (TBW) and water efflux from the body over a period of weeks.1 Water flux may be estimated from TBW measurement and from the turnover rate of the stable hydrogen isotope employing an adequate equation. This study was carried out to test the validity of this equation in premature infants. We measured weight and TBW with Deuteriumoxyde dilution in 6 prematures on the 8th and 21st day of life. Water intake was calculated from amount of formula (Humana 0) consumed. At age 8 days, weight was 1855 + 237 g (x + SD) and TBW 1352 + 142 g, accounting for 73% of weight. At age 21 days was 2125 + 244 g and TBW 1506 + 164 g, accounting for 71.6% of weight. Gain in water between 8 and 21 days, water efflux from the body and water intake is listed in the table: time interval i3 days

water intake

water efflux

162.3" (15.2)

158.8* (19.9)

water gain

diff. intake/ efflux t gain 2.2* (1.2%) (23.7)

.*ml/kg/day, x (SD) Mean water intake over 13 days as calculated by water efflux and gain was close to the amount calculated by formula intake. Water intake of the subjects was over- or underestimated by 20.7% to -17.7%. These preliminary data suggest that water flux rates as measured by Deuteriumoxyde dilution can be expected to be close to the actual flux rates in prematures. This method may be used to estimate breast milk (formula) intake over weeks or to measure water efflux under various conditions existent in intensive care nurseries. INagy,K.A., Costa,D.P.: Am J Physiol 238: R454-R465, 1980.

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