What Have We Learned About Acute Pancreatitis in Children?

To the Editor: Another consideration in the excellent review on pediatric acute pancreatitis in the March 2011 issue by Bai et al (1) is hypothermia. Hauer et al (2) reported acute pancreatitis in a case series of children with severe neurological impairment and associated hypothermia of central origin. Although hypothermia is an uncommon risk factor for the development of acute pancreatitis and consideration of other causes of pancreatitis is still warranted, it represents a potentially avoidable cause of recurrent pancreatitis. Recurrence of pancreatitis and prevention of associated effects of hypothermia, including pancytopenia, can be prevented by implementing simple measures to maintain a body temperature above 94° to 95°F (3). Interventions to meet this goal include a hat and scarf, because a significant proportion of heat loss occurs through the head and neck, along with gloves, thick socks, and blankets. The underlying mechanism involves impaired hypothalamic regulation, without a normal response to low body temperature, including lack of shivering and vasoconstriction (4,5). Cyproheptadine is also reported to minimize hypothermia in a few cases, possibly related to the cyclical pattern observed in some patients (6,7).