title: Asymptomatic hyperamylasemia and hyperlipasemia in pediatric patients with toxic epidermal necrolysis.
abstract: Although pancreatitis is rare in pediatric burn patients, elevated pancreatic enzymes have been recently observed among toxic epidermal necrolysis (TEN) patients. This clinical phenomenon has implications particularly for the nutritional management of patients involved. The objective of this study was to assess the frequency of sustained, elevated amylase, and lipase enzymes among children with TEN or Stevens Johnson Syndrome (SJS) and to evaluate the utilization of enteral nutrition support in this population. Medical records of 24 patients admitted to our hospital between January 1994 and October 2008 with TEN or SJS were retrospectively reviewed. Only patients with > or =4 consecutive measures for both amylase and lipase were included in this study (n = 10). Serial laboratory values were collected during the first 30 days of disease. Four patients (40%) had elevated amylase and lipase values, whereas six patients had values within normal limits. Patients with elevated pancreatic enzymes were significantly younger in age (4.7 +/- 1.7 years) than patients without elevated enzymes (11 +/- 5.9 years) and also had a higher incidence of sepsis. All other characteristics were similar between the groups. Enteral nutrition support was initiated within 4 days of admission in all 10 patients and did not correlate with elevated enzymes. Our findings suggest that hyperlipasemia and hyperamylasemia can occur in the pediatric population with TEN or SJS. Although the sample size in this study makes it difficult to determine the cause, sepsis may have been a contributing factor. In the absence of symptomatic pancreatitis, patients with TEN can safely meet nutritional goals orally or with standard enteral nutrition support.
authors.affiliation: Department of Nutrition Services, Shriners Hospitals for Children, Boston, Massachusetts, USA.
authors.forename: Maggie L
authors.initials: ML
authors.lastname: Dylewski
authors.forename: Kathy
authors.initials: K
authors.lastname: Prelack
authors.forename: Timothy
authors.initials: T
authors.lastname: Keaney
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
mesh_terms: D002056:Burns / Q000150:complications* / Q000201:enzymology*; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000209:etiology*; D008049:Lipase / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000201:enzymology* / Q000209:etiology
chemical_list: D008049:Lipase