Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis

Abstract

BackgroundHypocalcemia is a marker of poor prognosis in acute pancreatitis (AP) but the prognostic significance of hypocalcemic tetany in patients with AP has not been studied. We aimed to determine the prognostic significance of hypocalcemic tetany in patients with AP.MethodsConsecutive patients of AP who presented within 7 days of symptoms were included. Serum calcium levels were measured on admission and the patients were divided into two groups based on the presence (group 1) or absence of hypocalcemia (group 2). Chvostek and Trousseau signs were sought in all patients with hypocalcemia and the outcome measures were compared between patients with normocalcemia, asymptomatic and symptomatic hypocalcemia (tetany). The outcome parameters assessed were persistent organ failure (POF), need for intervention, and mortality.ResultsOf 105 patients (53 male; mean age 37.34±12.62 years), 37 (35.2%) had hypocalcemia (group 1) and 68 (64.8%) had normal corrected serum calcium levels (group 2). Patients with hypocalcemia had significantly higher frequency of POF, mortality and need for intervention (P<0.05). Twelve of 37 (32.4%) patients with hypocalcemia had tetany. Patients with tetany had significantly lower serum corrected calcium and ionized calcium levels compared with patients with asymptomatic hypocalcemia (P<0.05). Patients with tetany had significantly higher mortality rates compared with patients with asymptomatic hypocalcemia (100% vs. 8%; P=0.00001) as well as POF (100% vs. 32%; P=0.000006).ConclusionPresence of hypocalcemic tetany in AP patients bears a poor prognosis and is associated with increased mortality.

Prediction of Severity of Acute Pancreatitis Using Total Serum Calcium and Albumin-Corrected Calcium: A Prospective Study in Tertiary Center Hospital in Nepal

“…The largest multicenter study conducted in four hospitals of Australia on a cohort of 7024 patients showed that iCa < 0.8 mmol/L was an independent predictor of mortality in intensive care unit (ICU) patients [ 17 ]. In a study by Chhabra et al [ 18 ], patients with hypocalcemia in acute pancreatitis were found to have a significantly higher frequency of persistent organ failure and need for intervention as well as mortality compared with patients with normal serum calcium levels. The low corrected serum calcium levels had a sensitivity of 81.3% and a specificity of 87.6%, whereas lower ionized serum calcium levels had a sensitivity of 81.3% and specificity of 77.5% for prediction of mortality [ 18 ].…”

A Study of Tetany among the Saudi Population

“…It was assumed to be attributable to saponification of calcium by free fatty acids typically in areas of fat necrosis or dissolved or suspended in ascitic fluid [12] . Hypocalcemic tetany has a bad prognostic significance in acute pancreatitis [13] . TLS can cause acute kidney injury (AKI).…”

The role of phosphorus-calcium homeostasis and vitamin D in the pathogenesis of acute pancreatitis and assessment of its severity

“…Thus, the search for new pathogenetic factors of acute pancreatitis, and screening methods for predicting the severity of the disease remains relevant. As mentioned above, the role of disorders of calcium-phosphorus metabolism in this process is still not fully defined and controversial [9]. At the same time, the role of vitamin D in the pathogenesis of acute pancreatitis and as a predictor of its complications, in general, is just beginning to be studied and needs further study, which, in fact, is the subject of this work.…”