Critical illness polyneuropathy is the true spectrum for patients with acute pancreatitis in parenteral nutrition - Letter

Marik and Zaloga (1) reported that in patients with acute pancreatitis total parenteral nutrition, as compared to enteral nutrition, significantly increases the risk of infective complications, the likelihood of a surgical intervention and the length of hospital stay (1). Moreover, the detrimental effects of total parenteral nutrition were also associated with a trend towards increased complications, as well as adult respiratory distress syndrome, multi-organ failure, acute pseudocysts, and pancreatic fistula (1). Nevertheless, an important complication of total parenteral nutrition appears to be omitted. Parenteral nutrition, per se, has been related to the occurrence of critical illness polyneuropathy (2). Moreover, several cases of a polyneuropathy associated with pancreatitis are reported (3), and some patients with necrotizing pancreatitis may develop persistent polyneuropathy restricting daily life in survivors (4). In addition, infection and sepsis, complications related by Marik and Zaloga (1) to pancreatitis, may trigger peripheral neuropathy (5). These data, taken together, widely suggested that patients with acute pancreatitis who underwent total parenteral nutrition are at increased risk of critical illness polyneuropathy. As a consequence, enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis not only since infection is the most severe complication of parenteral nutrition in acute pancreatitis, as suggested by Marik and colleagues (1), but because the critical illness polyneuropathy could be the true spectrum for these patients. This aspect should be emphasized.