Letters to the Editor
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).
1. Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr 2011; 52:262–270.
2. Hauer JM. Central hypothermia as a cause of acute pancreatitis in children with neurodevelopmental impairment. Dev Med Child Neurol 2008; 50:68–70.
3. Lo L, Singer ST, Vichinsky E. Pancytopenia induced by hypothermia. J Pediatr Hematol Oncol 2002; 24:681–684.
4. MacKenzie MA, Hermus AR, Wollersheim HC, et al
. Poikilothermia in man: pathophysiology and clinical implications. Medicine (Baltimore) 1991; 70:257–268.
5. MacKenzie MA, Wollersheim HC, Lenders JW, et al
. Skin blood flow and autonomic reactivity in human poikilothermia. Clin Auton Res 1996; 6:91–97.
6. Ruiz C, Gener B, Garaizar C, et al
. Episodic spontaneous hypothermia: a periodic childhood syndrome. Pediatr Neurol 2003; 28:304–306.
7. Sheth RD, Barron TF, Hartlage PL. Episodic spontaneous hypothermia with hyperhidrosis: implications for pathogenesis. Pediatr Neurol 1994; 10:58–60.