Postoperative serum amylase predicts risk of pancreatic fistula after pancreaticoduodenectomy

Introduction: Fish Oil Based Lipid Emulsions (FOBLE) can potentially improve outcome in acute inflammatory conditions. However, lipid utilisation can be greatly impaired in these patients resulting in lipid disorders and “fat-overload” syndrome. The aim of this study was to evaluate the safety and tolerability of two lipid emulsions in patients with severe acute pancreatitis (SAP). Methods: A phase II single centre, double blind randomised control trial was conducted between October 2010 and February 2012. Forty-four patients with SAP were randomly assigned to receive a FOBLE (MCT/LCT/ Omega-3)(Lipidem 20%,BBraun)(study group, n1⁄422) or an MCT/LCT emulsion (Lipofundin MCT 20%,BBraun)(control group, n1⁄422). Lipid emulsions were initiated within 72 hours of symptom onset and infused daily at a dose of 2g/10ml per kg per day over 14 hours for a maximum of 7days. A non-fasting serum triglyceride and random cholesterol levels were obtained 6-10 hours post infusion on days 0, 1, 2, 3, 5 and 7. Standard care was provided including enteral or parenteral nutrition. Results: Both emulsions were well tolerated and with no unexpected severe adverse events noted. One critically ill patient developed transient hypertriglyceridemia, which resolved after temporary cessation of the MCT/LCT lipid emulsion. Another patient developed low-grade pyrexia which resolved by halving the MCT/LCT lipid emulsion dose. The mean post-infusion serum triglycerides and random cholesterol levels in the control group were slightly higher than the fish oil group at days 1, 2, 3, 5 and 7 (p1⁄4>0.05). Conclusion: Lipid emulsions can safely be infused in patients with SAP as long as manufacturer recommendations are followed. Take-home message: Lipid emulsions can safely be administered in SAP Abstract previously presented? no () Any disclosures? yes (D. Al-Leswas: Grant/Research Support from B Braun, A. Arshad: Grant/Research Support from B Braun, A. Eltweri: None declared,W.-Y. Chung: None declared, C. Pollard: None declared, O. Al-Taan: Grant/Research Support from B Braun, G. Garcea : None declared, M. Metcalfe: Grant/Research Support from B Braun, A. Dennison: Grant/Research Support from B Braun)