Propuesta de abordaje nutricional y dietoterapéutico basado en evidencia para el manejo integral en un paciente con pancreatitis aguda complicada con pseudoquiste pancreático: análisis retrospectivo de un caso clínico.

Abstract

Acute pancreatitis may induce a pronounced inflammatory response and hypercatabolic state, increasing the risk of muscle wasting and nutritional deterioration. This risk may be particularly relevant in critically ill patients with abdominal trauma and recent surgery. Objective: To develop a comprehensive, individualized nutritional intervention aimed at improving energy and protein provision, preserving muscle mass, and reducing nutrition-related complications during hospitalization. Methods: A retrospective analysis was conducted of the clinical case of a 53-year-old man with acute pancreatitis, pancreatic pseudocyst, abdominal trauma, exploratory laparotomy, osteosynthesis of the right radius, and obesity at baseline. Nutritional assessment was performed according to the Nutrition Care Process and incorporated clinical, anthropometric, biochemical, dietary, and functional data. The nutritional diagnosis was structured using the Problem, Etiology, and Signs/Symptoms framework. Nutritional intervention: The assessment identified inadequate oral intake, vomiting, abdominal distension, early satiety, an 8-kg weight loss over approximately five weeks, reduced calf circumference, and hypoalbuminemia. Oral nutrition was maintained provided that the patient remained hemodynamically stable, could swallow safely, and demonstrated adequate gastrointestinal tolerance. A complete, low-fat, soft or semi-solid diet was prescribed in five or six small meals, together with a high-protein oral nutritional supplement. The initial nutritional target was approximately 1,500 kcal/day and 1.3 g of protein/kg/day. If oral intake remained insufficient, progressive enteral nutrition was to be initiated, preferably through a nasogastric tube; a nasojejunal route would be considered in the presence of gastric intolerance. Monitoring: Daily follow-up included assessment of dietary intake, gastrointestinal tolerance, blood glucose, serum electrolytes, renal function, urine output, and fluid balance. Body weight, calf circumference, and handgrip strength were also monitored periodically. Conclusions: An early, progressive, and closely monitored nutritional strategy, prioritizing tolerated oral intake and avoiding prolonged fasting, was considered appropriate for supporting recovery and limiting further muscle loss during hospitalization.