The nature of hypocalcaemia in acute pancreatitis

McMahon, Michael; Woodhead, J. S.; Hayward, R. D.

doi:10.1002/bjs.1800650323

Cited by 42 publications

(21 citation statements)

References 13 publications

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“…In contrast, our findings are at variance with those of investigators who found low PTH levels in patients with acute pancreatitis, especially in cases with hypocalcaemia and more severe forms of the disease (Condon et al, 1975;Robertson et al, 1976;McMahon et al, 1978). Some of these workers (Condon et al, 1975) suggested that supplementary PTH might be given to patients with pancreatitis and hypocalcaemia, but we would contend, on the basis of the data presented, that this would be very rarely, if ever, justifiable or necessary.…”

Section: Discussioncontrasting

confidence: 88%

“…THE levels of parathyroid hormone (PTH) have been measured in the blood of patients with acute pancreatitis by several teams of investigators, with conflicting results. Some have reported low PTH levels associated with hypocalcaemia (Condon et al, 1975;Robertson et al, 1976;McMahon et al, 1978), while others described high levels of PTH and a significant inverse correlation with serum ionized calcium levels (Weir et al, 1975). A small number of patients were studied in each of these four reports, and in very few were sequential measurements of PTH levels recorded.…”

mentioning

confidence: 99%

“…This lack of serial PTH measurements results in difficulty in assessing the role of the hormone in calcium homeostasis in acute pancreatitis. In addition, only the most recent report (McMahon et al, 1978) took account of the hypoalbuminaemia which is the most common cause of a lowered total serum calcium level in patients with acute pancreatitis (Imrie et al, 1976).…”

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confidence: 99%

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Parathyroid hormone and calcium homeostasis in acute pancreatitis

Imrie

Beastall

Allam

et al. 1978

British Journal of Surgery

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Sequential daily measurements of plasma parathyroid hormone (PTH) have been performed in 89 patients with acute pancreatitis. A total of 439 PTH assays was obtained during 98 episodes of the disease. Three main patterns of PTH response were found. These responses were correlated with severity of disease graded by objective criteria and also to corrected serum calcium levels. The first type of PTH response was characterized by significantly elevated PTH levels soon after hospitalization with a subsequent decrease in levels to within the normal range by the third or fourth day of illness. This type of response was specifically associated with transient severe hypocalcaemia (corrected calcium less than 2.0 mmol/l). It was also associated with the most severe forms of disease and 6 of the 7 deaths. The second type of PTH response revealed initial PTH values in the upper level of the normal range (400--600 ng/l) while persistently low PTH levels were characteristic of the third type of response. Persistently low PTH levels were associated with normocalcaemia, and no patient in this group died. None of a group of 14 control patients exhibited the type 1 PTH response. An effective PTH response to an unidentified hypocalcaemic stimulus results in satisfactory calcium homeostasis in most patients with acute pancreatitis.

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Section: Discussioncontrasting

confidence: 88%

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Parathyroid hormone and calcium homeostasis in acute pancreatitis

Imrie

Beastall

Allam

et al. 1978

British Journal of Surgery

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“…Edmondson and Berne (4) found that patients with severe pancreatitis developed low serum calcium levels, and the association between hypocalcaemia and severity has been verified by more recent reports (2,5,6).…”

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confidence: 69%

A comparative study of methods for the prediction of severity of attacks of acute pancreatitis

McMahon

Playforth

Pickford

1980

British Journal of Surgery

172

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Diagnostic peritoneal lavage was carried out in 79 patients with acute pancreatitis, at a mean time of 7 h after admission to hospital. The presence of more than 10 ml of free peritoneal fluid, brown-coloured free fluid or mid-straw-coloured lavage fluid was the criterion used for the prediction of a severe attack by lavage. Prior to lavage the attack was assessed as mild or severe by the clinician and reassessed by him at 24 and 48 h. All attacks were finally classified as mild or severe by means of a simple clinical grading scheme. There were 61 mild and 18 severe attacks (including 4 deaths). Initial clinical assessment correctly predicted only 39 per cent of the severe attacks compared with a 72 per cent succwss rate for diagnostic lavage. All the mild attacks were correctly predicted by clinical assessment but lavage was wrong in 3 out of 61 cases (95 per cent success rate). By 48 h after admission clinical assessment was comparable to systems using multiple criteria in its predictive value, success rates being 83 per cent and 82 per cent respectively for prediction of severe attacks. We did not find either the presence of methaemalbumin in the serum or the presence of hypocalcaemia to be of additional value. Diagnostic peritoneal lavage was the most accurate early guide to severity, and correctly predicted all patients who developed shock or died.

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“…12,13 Proposed mechanisms for hypocalcaemia in early phase are autodigestion of mesenteric fat by pancreatic enzymes and release of free fatty acids, which form calcium salts, transient hypoparathyroidism, and hypomagnesemia. [14][15][16] Later stages of pancreatitis are frequently complicated by sepsis. Whitted et al proposed that increased circulating catecholamines in sepsis cause a shift of circulating calcium into the intracellular compartment, leading to relative hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis

2018

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Background: Acute pancreatitis is an acute inflammatory process of the pancreas. The Ranson and the modified Glasgow scores require 48 hours of data collection to asses' severity. Hypocalcaemia is one of the components of Ranson's scoring system done to assess the severity of pancreatitis. Albumin-corrected calcium (ACC) has also been associated with severity, but no study has evaluated it as a prognostic severity factor within the first 24 h of the patient's hospital admission. This study tries to evaluate total calcium and albumin corrected calcium as prognostic severity markers in acute pancreatitis within first 24 hour of admission. Methods: This prospective study was conducted in Bowring and Lady Curzon hospital, a tertiary care centre from June 2016 to May 2018. Inclusion criteria included all patients above 18 years of age, who presented within 72 hours of onset of epigastric pain. The clinical and demographic data with respect to gender, age, previous history of pancreatitis, total calcium taken 24 h after admission. In order to evaluate total calcium and albumin corrected calcium as prognostic factors of severity, the lowest total calcium values were collected within the first 24 h of hospital admission. These values were then corrected according to the serum albumin level. Results: A total of ninety-four patients were included in the study. There was no significant difference in the age of patients in each severity grade (p value: 0.242). No difference was observed in gender distribution of three groups. (P >0.05). As compared to total calcium, mean values of albumin corrected calcium were 8.03, 7.18 and 6.28 for mild, moderate and severe acute pancreatitis respectively, which were also significant at 0.05. Conclusions: Total calcium and albumin-corrected calcium obtained within the first 24 hours of hospital admission are useful predictors of severity in acute pancreatitis.Cite this article as: Kemparaj T, Narasimhamurthy KN, Muralidhar A. Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis. Int Surg J 2018;5:3558-61.

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The nature of hypocalcaemia in acute pancreatitis

Cited by 42 publications

References 13 publications

Parathyroid hormone and calcium homeostasis in acute pancreatitis

Parathyroid hormone and calcium homeostasis in acute pancreatitis

A comparative study of methods for the prediction of severity of attacks of acute pancreatitis

Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis

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