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VOLUME 20 , ISSUE 3 ( 2016 ) > List of Articles


Hypocalcemia in acute pancreatitis revisited

Arvind Kumar Baronia

Keywords : Acute pancreatitis, calcium, hypocalcemia

Citation Information : Baronia AK. Hypocalcemia in acute pancreatitis revisited. Indian J Crit Care Med 2016; 20 (3):173-177.

DOI: 10.4103/0972-5229.178182

License: CC BY-ND 3.0

Published Online: 01-10-2013

Copyright Statement:  Copyright © 2016; The Author(s).


Hypocalcemia is a frequent finding in acute pancreatitis. Severe hypocalcemia can present with neurological as well as cardiovascular manifestations. Correction of hypocalcemia by parenteral calcium infusion remains a controversial topic as intracellular calcium overload is the central mechanism of acinar cell injury in pancreatitis. The current article deals with the art and science of calcium correction in pancreatitis patients.

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  1. Forsythe RM, Wessel CB, Billiar TR, Angus DC, Rosengart MR. Parenteral calcium for intensive care unit patients. Cochrane Database Syst Rev 2008;4:006163.
  2. Slomp J, van der Voort PH, Gerritsen RT, Berk JA, Bakker AJ. Albumin-adjusted calcium is not suitable for diagnosis of hyper- and hypocalcemia in the critically ill. Crit Care Med 2003;31:1389-93.
  3. Riggs JE. Neurologic manifestations of electrolyte disturbances. Neurol Clin 2002;20:227-39.
  4. Fong J, Khan A. Hypocalcemia: Updates in diagnosis and management for primary care. Can Fam Physician 2012;58:158-62.
  5. Gardner JD, Calkins JB Jr., Garrison GE. ECG diagnosis: The effect of ionized serum calcium levels on electrocardiogram. Perm J 2014;18:e119-20.
  6. Benzarouel D, Hasni K, Ashab H, El Hattaoui M. A reversible cause of dilated cardiomyopathy: Hypocalcemia. Ann Cardiol Angeiol (Paris) 2014;63:102-6.
  7. Jankowski S, Vincent JL. Calcium administration for cardiovascular support in critically ill patients: When is it indicated? J Intensive Care Med 1995;10:91-100.
  8. Li J, Zhou R, Zhang J, Li ZF. Calcium signaling of pancreatic acinar cells in the pathogenesis of pancreatitis. World J Gastroenterol 2014;20:16146-52.
  9. Dias C, Carreira LM. Serum ionised calcium as a prognostic risk factor in the clinical course of pancreatitis in cats. J Feline Med Surg 2015;17:984-90.
  10. Ammori BJ, Barclay GR, Larvin M, McMahon MJ. Hypocalcemia in patients with acute pancreatitis: A putative role for systemic endotoxin exposure. Pancreas 2003;26:213-7.
  11. Zaloga GP. Hypocalcemia in critically ill patients. Crit Care Med 1992;20:251-62.
  12. Zivin JR, Gooley T, Zager RA, Ryan MJ. Hypocalcemia: A pervasive metabolic abnormality in the critically ill. Am J Kidney Dis 2001;37:689-98.
  13. Condon JR, Ives D, Knight MJ, Day J. The aetiology of hypocalcaemia in acute pancreatitis. Br J Surg 1975;62:115-8.
  14. McMahon MJ, Woodhead JS, Hayward RD. The nature of hypocalcaemia in acute pancreatitis. Br J Surg 1978;65:216-8.
  15. Ryzen E, Rude RK. Low intracellular magnesium in patients with acute pancreatitis and hypocalcemia. West J Med 1990;152:145-8.
  16. 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.
  17. 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.
  18. Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Crit Care 2013;17:R106.
  19. Chung HS, Kim YS, Lee JM, Hong SH, Lee SR, Park CS. Intraoperative calcium-related risk factors for biochemical acute pancreatitis after living-donor liver transplantation. Transplant Proc 2011;43:1706-10.
  20. Collage RD, Howell GM, Zhang X, Stripay JL, Lee JS, Angus DC, et al. Calcium supplementation during sepsis exacerbates organ failure and mortality via calcium/calmodulin-dependent protein kinase (CaMKK) signaling. Crit Care Med 2013;41:e352-60.
  21. Carlstedt F, Eriksson M, Kiiski R, Larsson A, Lind L. Hypocalcemia during porcine endotoxemic shock: Effects of calcium administration. Crit Care Med 2000;28:2909-14.
  22. Steinhorn DM, Sweeney MF, Layman LK. Pharmacodynamic response to ionized calcium during acute sepsis. Crit Care Med 1990;18:851-7.
  23. Miura S, Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, et al. Association of hypocalcemia with mortality in hospitalized patients with heart failure and chronic kidney disease. J Card Fail 2015;21:621-7.
  24. Vincent JL, Bredas P, Jankowski S, Kahn RJ. Correction of hypocalcaemia in the critically ill: What is the haemodynamic benefit? Intensive Care Med 1995;21:838-41.
  25. Mithöfer K, Fernández-del Castillo C, Frick TW, Lewandrowski KB, Rattner DW, Warshaw AL. Acute hypercalcemia causes acute pancreatitis and ectopic trypsinogen activation in the rat. Gastroenterology 1995;109:239-46.
  26. Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013;28:166-77.
  27. Frick TW, Mithöfer K, Fernández-del Castillo C, Rattner DW, Warshaw AL. Hypercalcemia causes acute pancreatitis by pancreatic secretory block, intracellular zymogen accumulation, and acinar cell injury. Am J Surg 1995;169:167-72.
  28. Bai HX, Giefer M, Patel M, Orabi AI, Husain SZ. The association of primary hyperparathyroidism with pancreatitis. J Clin Gastroenterol 2012;46:656-61.
  29. Debnath NB, Chowdhury A, Maitra S, Ghosh A, Roychowdhury P. Multiple myeloma presenting as acute pancreatitis. Indian J Gastroenterol 1999;18:127-8.
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