Inclusion Criteria:  Adults 19 years and older Hospitalized in the surgical/medical intensive care unit of the Seoul National University Hospital Enteral nutrition Patients who consented to this study  Patients with risk factors for pancreatic exocrine dysfunction  Shock (Norepinephrine) Sepsis (3 rd definition of sepsis) Diabetes Cardiac arrest hyperlactatemia serum lactate > 2 mmol/L) Mechanical ventilation Continuous renal replacement therapy  Exclusion Criteria:  chronic pancreatitis unresectable pancreatic cancer History of pancreatectomy  Underlying diseases in which the effect of Exocrine pancreatic enzyme administration is difficult to show  Inflammatory bowel disease Short bowel syndrome