Serum ionized calcium in acute pancreatitis

Abstract

Measurement of serum ionized calcium was performed daily for 7 days after admission in 8 consecutive patients with acute pancreatitis. The results support the findings of our previous study that the most common cause of the low serum calcium often found in patients with this disease is a low serum albumin; when correction of serum calcium is made for hypo-albuminanemia, most patients are found to be normocalcaemic. The occasional hypocalcaemia as shown by the 'corrected' serum calcium or by serum ionized calcium measurement is usually mild and transient, indicating that the normal homoeostatic mechanisms of the body can efficiently maintain the physiologically active fraction of the serum calcium within, or close to, the normal range. These findings explain the rarity of overt and subclinical tetany in acute pancreatitis. This study has shown that correction of serum calcium for albumin provides similar information to the direct measurement of serum ionized calcium. The value of 'apparent' hypocalcemia in assessing severity of acute pancreatitis requires reappraisal, while greater attention should be directed towards the investigation and management of hypoalbuminaemia in this disease.

Parathyroid hormone and calcium homeostasis in acute pancreatitis

“…He was not given the glucose-insulin-potassium infusion therapy which had previously proved beneficial. Both clinically and biochemically, he was similar to a patient with features of the sick cell syndrome (Flear and Singh, 1973), who was reported in our earlier study (Allam and Imrie, 1977).…”

“…is serum albumin in g/l and Ca (corrected) is serum calcium in mmol/l corrected for albumin. The full derivation of this formula, its validation and the methods used in the measurement of total serum calcium, albumin and phosphate have previously been described in detail (Imrie et al, 1976;Allam and Imrie, 1977). The normal serum calcium level for our laboratory is 2.20-2.60 mmoljl, albumin 42-52 g/l (purified human albumin used as a standard).…”

“…We carried out the present study of sequential daily analysis of PTH levels in a larger series of patients (n = 90) to elucidate the efficacy or otherwise of calcium homeostasis in acute pancreatitis. Our previous work had validated the use of a correction factor for serum calcium Ievels according to 57 changes in serum albumin based on measurements of serum ionized calcium in sequential blood samples of patients with acute pancreatitis (Allam and Imrie, 1977). An additional aim of this study was to provide a rational basis for the therapy of true hypocalcaemia in severe acute pancreatitis and to assess the place of supplementary PTH or calcium (gluconate or chloride) or other approaches.…”

Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features

“…Hypokalemia and polyuria in patients with leptospirosis suggest an increase in distal potassium secretion secondary to increased distal sodium delivery 32 . Ionic hypocalcemia was also observed and could be due to rhabdomyolysis or acute pancreatitis 1,24,27,36 .…”

\Risk Factors for Morbidity and Mortality in Pancreatitis

“…It is a marker of severe pancreatitis and is one of the early signs in Ranson's criteria [23], Fan et al [24] found that elevated serum urea (>7.4 mmol/1) and glucose (> 11.0 mmol/1) levels correlated with the severity of acute attack. Certain acute phase reactants in the serum or urine of patients are predictive of severe acute pancreatitis, for example, a^-macroglobulin [25], urinary trypsinogen activation peptide [26] and granulocytic elastase [27], Peak or 7th-day level of serum C-reactive pro tein concentration provides comparable accu racy to Ranson's criteria in predicting severe acute pancreatitis [28].…”