title: Toxic-metabolic Risk Factors in Pediatric Pancreatitis: Recommendations for Diagnosis, Management, and Future Research.
abstract: Pancreatitis in children can result from metabolic and toxic risk factors, but the evidence linking these factors is sparse. We review the evidence for association or causality of these risk factors in pancreatitis, discuss management strategies, and their rationale. We conducted a review of the pediatric pancreatitis literature with respect to the following risk factors: hyperlipidemia, hypercalcemia, chronic renal failure, smoking exposure, alcohol, and medications. Areas of additional research were identified. Hypertriglyceridemia of 1000 mg/dL or greater poses an absolute risk for pancreatitis; persistent elevations of calcium are predisposing. Further research is necessary to determine whether end-stage renal disease leads to increased pancreatitis in children similar to adults. It is unknown whether cigarette smoking exposure, which clearly increases risk in adults, also increases risk in children. The role of alcohol in pediatric pancreatitis, whether direct or modifying, needs to be elucidated. The evidence supporting most cases of medication-induced pancreatitis is poor. Drug structure, improper handling of drug by host, and bystander status may be implicated. Other pancreatitis risk factors must be sought in all cases. The quality of evidence supporting causative role of various toxic and metabolic factors in pediatric pancreatitis is variable. Careful phenotyping is essential, including search for other etiologic risk factors. Directed therapy includes correction/removal of any agent identified, and general supportive measures. Further research is necessary to improve our understanding of these pancreatitis risk factors in children.
authors.affiliation: *Children's Hospital of Pittsburgh, Pittsburgh, PA †Montreal Children's Hospital, McGill University, Montreal, QC, Canada ‡University of Utah, Salt Lake City §Cincinnati Children's Hospital Medical Center, Cincinnati, OH ||University of Minnesota Masonic Children's Hospital, Minneapolis ¶Harvard Medical School, Boston, MA #First Department of Medicine, University of Szeged and HAS-SZTE Monument Gastroenterology Multidisciplinary Research Group, Szeged, Hungary **University of California at San Francisco, San Francisco ††Baylor College of Medicine, Houston, TX ‡‡Discipline of Paediatrics, School of Women's and Children's Health, Medicine, University of New South Wales and Sydney Children's Hospital Randwick, Sydney, Australia §§University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Sohail Z
authors.initials: SZ
authors.lastname: Husain
authors.forename: Veronique
authors.initials: V
authors.lastname: Morinville
authors.forename: John
authors.initials: J
authors.lastname: Pohl
authors.forename: Maisam
authors.initials: M
authors.lastname: Abu-El-Haija
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Steve
authors.initials: S
authors.lastname: Freedman
authors.forename: Peter
authors.initials: P
authors.lastname: Hegyi
authors.forename: Melvin B
authors.initials: MB
authors.lastname: Heyman
authors.forename: Ryan
authors.initials: R
authors.lastname: Himes
authors.forename: Chee Y
authors.initials: CY
authors.lastname: Ooi
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schwarzenberg
authors.forename: Danielle
authors.initials: D
authors.lastname: Usatin
authors.forename: Aliye
authors.initials: A
authors.lastname: Uc
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects; D035843:Biomedical Research / Q000379:methods / Q000639:trends; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions / Q000503:physiopathology; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000503:physiopathology; D015228:Hypertriglyceridemia / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D010195:Pancreatitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D010372:Pediatrics / Q000379:methods* / Q000639:trends; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects