March 1980 The Journal of P E D I A T R I C S 407 The ultrasonic and biochemical diagnosis of pancreatitis in children Pancreatic ultrasonography and the determination of serum amylase and amylase creatinine clearance ratio were performed on 17 normal children and on 35 children with abdominal pain. In all 17 normal subjects the eehodensity of the pancreas was equal to or greater than that of the liver. Nineteen patients with abdominal pain had reduced echodensity of the pancreas when compared to that in normal children, and two of the 19 had pseudoeysts. Serum amylase values and~or amylase creatinine clearance ratio correlated poorly with ultrasonic and clinical evidence of pancreatitis. Kenneth L. Cox, M.D.,* Marvin E. Ament, M.D., William F. Sample, M.D., Dennis A. Sarti, M.D., Michael O'Donnell, Ph.D., and William J. Byrne, M.D., Los Angeles, Calif. AN ELEVATION of serum amylase activity greater than three times normal is usually diagnostic of pancreatitis. 1 However, in conditions other than pancreatitis, such as biliary disease, perforated peptic ulcer, and abdominal trauma, serum amylase values may be more than three times normal, and in acute pancreatitis serum amylase activity may be normal. -~ 6 Jordan and Ament ~ reported that seven of 47 children With pancreatitis had normal serum amylase values at presentation. ~ The newer diagnostic techniques, amylase creatinine clearance ratio and pancreatic ultrasonography, may prove helpful in identifying pancreatitis in children, especially in those who have normal serum amylase values. The purposes of this study were to determine the normal echo pattern of the pancreas in children and to correlate serum amylase values, amylase creatinine clear- ance ratios, and pancreatic sonograms in children with abdominal pain to determine their effectiveness in identi- fying pancreatitis. MATERIALS AND METHODS Fifty-two patients between 3 months and 18 years of age were evaluated at UCLA Center for Health Science Dr. Cox was a cystic fibrosis fellow at UCLA when this study was conducted.. *Reprint address'. Department of Pediatrics, FOLB 11, "D," University of Calijbrnia-Davis Medical Center; 4301 "X'" St.. Sacramento, CA 9581Z between 4/1/76 and 4/1/78 with pancreatic ultrasonogra- phy and determinations of serum amylase and amylase creatinine clearance ratios. Seventeen patients were asymptomatic control subjects who for at least six months prior to the study bad not had abdominal pain and had not used medications known to cause pancreatitis. Four children had Crohn disease with remission of symptoms for over six months, four chi',dren had gastroesophageal reflux, three had cow milk protein intolerance, two had constipation, and four did not have a history of gastrointestinal disease. There were 14 males and 3 females. They had a mean age of 7.0 years, ranging from 3 months to 17 years. Abbreviations used ACCR: amylase creatinine clearance ratios UGI: upper gastrointestinal Thirty-five patients had been referred to UCLA pediat- ric gastroenterology service for evaluation of abdominal pain. There were 18 males and 17 females. Their ages ranged from 3 to 18 years. Single voided urine samples and venous blood speci- mens were obtained within 2 hours of each other for amylase and creatinine determinations. Serum and urine amylase values were determined by an automated adap- tation of the Somogyi saccharogenic method? Normal serum amylase values established for pediatric patients at 0022-3476/80/030407+05500.50/0 9 1980 The C. V. Mosby Co. Vol. 96, No. 3, Part 1, pp. 407-411