why there is hypocalcemia in severe pancreatitis?
hari | Dec 20, 2009 | 5 comments
According to the modified glasgow criteria for pedicting severity of pancreatitis ,(mnemonic as PANCREAS).Do you know guys,, why there is low serum calcium in patients with severe pancreatitis?? recently i have gone through harrison’s and it is written that, the pathogenesis is still unknown.it is said that one reason maybe due to intraperitoneal saponification of calcium by fatty acids in areas of fat necrosis.
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Filed Under: Discussion • Endocrine
thanks drhari
ya you are right but there is still unknown pathogenis of hypocalcemia during acute pancreatic.
some scientist proposed some hypothesis ,according to them ,Deficiency of parathyroid hormone due to its destruction by proteolytic enzymes or because of parathyroid gland exhaustion is suggested as the major factor inducing persistent hypocalcaemia in acute pancretitis and some believed that hypocalcemia is due to saponification of calcium by fatty acids in areas of fat necrosis as drhari said..
References:
1.www.ncbi.nlm.nih.gov
2.emedicine.medscape.com
hypocalcemia may appear as early as the first day of disease because albumin leaks into the the retroperitoneum. Increasing serum albumin proportionally increases serum calcium. Infrequently, loss of ionized calcium is due to calcium deposition within fat necrosis, hypomagnesemia , or bone refractoriness to an adequate parathyriod response. Indeed parathyiod secretion in response to hypocalcemia in severe acute pancreatitis. IN hypertryglyceridemia, calcium binding to serum free fatty acids also explain hypocalcemia.
i think i was able clear the cause.. if any plez relpy!!
thank you drbibek
It makes sense
It is caused primarily by precipitation of calcium soaps in the abdominal cavity,when the pancreas is damaged, free fatty acids are generated by the action of pancreatic lipase. Insoluble calcium salts are present in the pancreas, and the free fatty acids avidly chelate the salts, resulting in calcium deposition in the retroperitoneum.In the other way glucagon-stimulated calcitonin release and decreased PTH secretion may play a role. . In addition, hypoalbuminemia may be a part of the clinical picture, resulting in a reduction in total serum calcium as bivek said. In patients with concomitant alcohol abuse, a poor nutritional intake of calcium and vitamin D, as well as accompanying hypomagnesemia, may predispose those with pancreatitis to hypocalcemia.
Some studies shows that systemic endotoxin exposure and extraskeletal sequestration of calcium appears to play a significant role in the development of hypocalcemia in patients with acute pancreatitis.
[...] Serum calcium level decrease. [...]