Executive Summary

An estimated 80,000 cases of acute pancreatitis occur each year in the United States, with biliary tract disease and alcoholism as the cause in 80 % of these cases. The remaining 20 % are attributed to drugs (e.g., azathioprine, corticosteroids, thiazide diuretics, and estrogens), hypertriglyceridemia, infection (eg, mumps), vascular disease, blunt trauma, structural abnormalities, hyperparathyroidism and hypercalcemia, or renal transplantation1. Individuals suffering from autoimmune diseases are often forced to choose between the symptoms of their condition and the side effects of chronic drug use to control those symptoms. In the case presented here, the patient was admitted for acute pancreatitis as a result of a combination of chronic corticosteroid use, which she requires for the control of her complex disease state, and a history of elevated lipids. The standard of care for acute pancreatitis is bowel rest until the condition resolves, usually on its own, in an average of 5-7 days. TPN is warranted only in cases where the resolution of pancreatic enzymes is excessively prolonged, or when pancreatitis is accompanied by an overt hypermetabolic state (increased energy needs, proteolysis, and glucose production)2. In the case of an already malnourished individual, however, therapy must be tailored to meet these special needs, and TPN may be necessary earlier. The following case study addresses a complex case of acute pancreatitis in an individual with several overlapping autoimmune diseases, including systemic lupus erythamatosis, Sjögren’s Syndrome, and severe celiac sprue. The dietitian is challenged to meet the increased energy and nutrient needs of a patient with decreased absorption and many food intolerances, while providing the bowel rest needed for resolution of pancreatitis.