Pancreas Enzyme Replacement Therapy

By JoAnn Coleman DNP, ACNP, AOCN, RN

What Nurses Need to Know

The goal of this continuing education activity is to provide nurses and nurse practitioners with knowledge and skills to recognize and manage blood transfusion reactions. Below is an introduction of the topic. Read the article in full online. After reading this article you will be able to:

• Describe indications for pancreatic enzyme therapy
• Identify signs and symptoms of pancreatic enzyme insufficiency
• Explain nursing considerations for administration of pancreatic enzyme therapy

Pancreatic enzymes are natural chemicals that help break down fat, proteins, and carbohydrates. They help maintain weight, aid in weight gain, neutralize stomach acid, and also promote nutrient absorption. A normally functioning pancreas secretes about 64 ounces of fluid daily into the duodenum. Pancreas enzyme replacement therapy is indicated for people who do not produce adequate enzymes and are therefore unable to properly digest food. Examples of conditions characterized by pancreatic enzyme deficiencies include cystic fibrosis, chronic pancreatitis, pancreatic cancer, pancreatic resection—such as the Whipple procedure (pancreaticoduodenectomy)—or a total pancreatectomy.

What are signs and symptoms of pancreatic enzyme insufficiency?

Individuals who do not produce ade-quate pancreatic enzymes experience malabsorption. Signs of malabsorption include weight loss or inability to gain weight despite a good appetite; frequent, loose and large bowel movements; foul-smelling bowel movements; mucus or oil in the bowel movement; excessive gas and/or stomach pain; and distention or bloating. Steatorrhea, the presence of excess fat in the stool, is common in individuals with pancreatic enzyme deficiencies; these stools float in water, have an oily appearance and may be very foul-smelling.

What is pancreatic enzyme replacement therapy?

Most pancreatic enzyme supplements contain a mixture of digestive enzymes including lipase, protease, and amylase that are derived from porcine pancreas. Lipase works with bile from the liver to break down fat molecules so they can be absorbed and used by the body. A shortage of lipase may cause lack of needed fats and fat-soluble vitamins, diarrhea and/or fatty stools. Amylase breaks down carbohydrates (starch) into sugars which are then more easily absorbed by the body. This enzyme is also found in saliva. A shortage of this enzyme may cause diarrhea due to the effects of undigested starch in the colon. Protease breaks down proteins. This enzyme helps to keep the intestine free of parasites such as bacteria, yeast and protozoa. Lack of protease may cause allergies or the formation of toxic substances due to incomplete digestion of proteins and increased risk of intestinal infections.

Pancreatic enzyme replacement therapy comes in different formulations and dosages. The enzyme preparations are dosed by lipase content (5000 units, 10,000 units, etc.). Pancreatic enzyme is typically titrated: replacements are started at a low dose and gradually increased if symptoms do not resolve. It is best for the provider to start with an order for the smallest possible dose and adjust the dose based on patient response. The amount of pancreatic enzymes required will vary with the amount of foods consumed, and may need to be increased for larger meals.

Pancreatic enzyme replacements are dosed in capsule form. Inside each capsule are many small “beads” that contain the digestive enzymes. Each bead is covered with a special enteric coating that allows the beads to dissolve in the small intestine. The digestive enzymes are then released in the small intestine to aid in food digestion.

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This 1.0 contact hour Educational Activity is provided by the Institute for Johns Hopkins Nursing.

The Institute for Johns Hopkins Nursing is approved as a provider of nurse practitioner continuing education by the American Academy of Nurse Practitioners: AANP Provider Number 061216.

This program has been granted 1.0 contact hours of continuing education (which includes 0.5 of pharmacology hours).

Contact hours will be awarded until July 31, 2014. Receive FREE contact hours at www.nursing.jhu.edu/ce.