Categories: Endocrinology

Hypocalcemia and Pancreatitis: Mechanism

Various studies have demonstrated Hypocalcemia as a poor prognostic marker in patients with pancreatitis. It is often apart of severity scoring (i.e Ranson/ APACHE II) to assess the severity of pancreatitis.

HOW DOES IT CAUSE HYPOCALCEMIA?

Exact mechanism of hypocalcemia in acute pancreatitis is unknown. The proposed mechanisms include:

1) Auto digestion of mesenteric fat by pancreatic enzyme (Lipase) and release of free fatty acids, which bind calcium and precipitate out as insoluble calcium salts; dropping serum levels.

2) Later stages of pancreatitis are frequently complicated by sepsis, which becomes an important contributor to hypocalcemia. Increased circulating release catecholamines during sepsis and pancreatic break down can shift calcium intracellular.

3) Hypomagnesaemia-induced impaired PTH secretion and action may have a role

REFERENCES

  1. Egi M, Kim I, Nichol A, Stachowski E, French CJ, Hart GK, et al. Ionized calcium concentration and outcome in critical illness. Crit Care Med. 2011;39:314–21.
  2. Ahmed A, Azim A, Gurjar M, Baronia AK. Hypocalcemia in acute pancreatitis revisited. Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2016;20(3):173-177. doi:10.4103/0972-5229.178182.
  3. Whitted AD, Stanifer JW, Dube P, Borkowski BJ, Yusuf J, Komolafe BO, et al. A dyshomeostasis of electrolytes and trace elements in acute stressor states: Impact on the heart. Am J Med Sci. 2010;340:48–53
  4. ondon JR, Ives D, Knight MJ, Day J. The aetiology of hypocalcaemia in acute pancreatitis. Br J Surg. 1975 Feb;62(2):115-8.C
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Dr. C Humphreys

Internal Medicine

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