Pancreatic Enzyme Replacements

A client with repeated bulky, oily stools, abdominal gas, and unintentional weight loss may be losing calories in the toilet rather than absorbing them. This pattern suggests pancreatic exocrine insufficiency (PEI): too little active pancreatic enzyme reaches the intestinal lumen. Lipase, protease, and amylase normally digest fat, protein, and carbohydrate. When enzyme activity is inadequate, maldigestion produces steatorrhea and nutritional deficiency, particularly deficiencies of vitamins A, D, E, and K. Pancreatic enzyme replacement therapy (PERT), usually pancrelipase or pancreatin, supplies these enzymes where food is being digested. It does not restore pancreatic tissue or replace insulin. For an RPN, the clinical task is to make sure the prescribed product reaches the client with the meal or snack, then determine whether stools, weight, hydration, and nutritional status are improving. Dose selection and dose changes require the authorized prescriber and the applicable provincial and employer policy; persistent symptoms are a reason to assess administration and escalate, not to independently increase the dose.