Necrotizing Pancreatitis: Metabolic Characteristics
The correct answer is A: Increased lipolysis occurs in necrotizing pancreatitis as part of the hypermetabolic and catabolic state that characterizes this severe inflammatory condition.
Metabolic Derangements in Necrotizing Pancreatitis
Hypermetabolic and Catabolic State
Necrotizing pancreatitis induces a profound hypermetabolic state with significant catabolism, which is a hallmark feature distinguishing patients who are "failing to thrive" from those recovering appropriately 1. This metabolic profile includes:
- Increased lipolysis: Fat breakdown is accelerated as part of the systemic inflammatory response and energy mobilization 1
- Increased gluconeogenesis (not decreased): The body generates glucose from non-carbohydrate sources to meet elevated energy demands 1
- Protein catabolism (not synthesis): Muscle and tissue proteins are broken down rather than synthesized, contributing to the wasting seen in severe disease 1
- Hyperglycemia (not hypoglycemia): Blood glucose levels are typically elevated due to stress response, increased gluconeogenesis, and insulin resistance 1
Clinical Significance of the Hypermetabolic State
The British Society of Gastroenterology specifically describes patients with necrotizing pancreatitis as requiring "continued system support with features of hypermetabolism and a catabolic state which suggest the development of complications" 1. This metabolic profile:
- Indicates disease severity and potential for complications 1
- Necessitates early nutritional support to counteract catabolism 2
- Requires intensive monitoring in HDU/ICU settings 2
Nutritional Implications
The hypermetabolic and catabolic state directly informs management strategies:
- Early enteral nutrition is essential to prevent gut failure and provide substrate for the elevated metabolic demands 2
- Enteral feeding should be initiated via nasogastric or nasojejunal tube within 24 hours when tolerated 2
- The goal is to counteract the protein catabolism and support the increased energy expenditure 2
Why Other Options Are Incorrect
Hypoglycemia (Option B): This is incorrect because necrotizing pancreatitis causes hyperglycemia, not hypoglycemia, due to stress-induced hormonal responses and increased gluconeogenesis 1.
Decreased gluconeogenesis (Option C): This is the opposite of what occurs; gluconeogenesis is actually increased to meet elevated energy demands 1.
Protein synthesis (Option D): Protein catabolism, not synthesis, predominates in the catabolic state of necrotizing pancreatitis 1.