Necrotizing pancreatitis due to hypercalcemia in a hemodialysis patient with pica

Pica refers to the persistent, compulsive craving for and ingestion of nonfood items and certain food items. Pica is quite common among dialysis patients. The nutrient composition of some of the substances ingested may contribute to severe metabolic and mineral disturbances and other serious medical complications. We report the first case of a hemodialysis patient with chalk pica associated hypercalcemia who developed acute necrotizing pancreatitis. Hydration, nutritional support and hemodialysis treatments with low-calcium bath led to clinical improvement and correction of his calcium. This case illustrates the dangers of pica in dialysis patients and describes modalities of treatment and detection of this high risk behavior.