Acute pancreatitis in children with anticholinesterase insecticide intoxication

Gastrointestinal symptoms are commonly seen in anticholinesterase insecticide intoxication. A few studies in adults have demonstrated some evidence for pancreatic damage in this poisoning. To see whether this association exists also in children, we conducted a prospective study in 17 consecutive children with typical organophosphate and carbamate poisoning. On admission and following recovery, serum amylase, immunoreactive trypsin, glucose, calcium, urea, creatinine, and arterial blood gas values were determined and compared with those of age-matched control subjects. Acute pancreatitis was diagnosed in 5 subjects. They demonstrated significantly elevated (greater than mean + 2 SD) serum levels of both immunoreactive trypsin (914.0 ± 317.4 ng/mL, 159.9 ± 36.4 ng/mL, and 169.7 ± 41.2 ng/mL, respectively; P < .01) and amylase (448.0 ± 264.4 U/L, 152.8 ± 90.9 U/L, and 56.8 ± 26.3 U/L, respectively; P < .001; n = 4), compared with other patients and control subjects. Gastrointestinal symptoms were noted in all 5 subjects, with severe abdominal pain in 2. Such symptoms were evident in only 41% of the other 12 patients. Serum glucose levels were significantly elevated in these subjects compared with others (389.0 ± 66.2 mg/100 mL vs 180.4 ± 72.3 mg/100 mL; P < .01). None had hypocalcemia, renal dysfunction, or acidosis. All had complete recovery. It is concluded that acute pancreatitis is probably not rare in children with anticholinesterase insecticide poisoning. This may contribute to the development of gastrointestinal symptoms and hyperglycemia often observed in these patients.