25 years old lady presented in OPD with the chief complaints of fever, cough, cold and chest pain since 3 days during physical examination there was presents of crackles in the right middle lobe of the lung .X-ray was done x-ray shows consolidation on right middle lobe of the lung. She was diagnosed as lobar pneumonia and discharge with giving antibiotic. After 1 hour she again presented in Emergency with hyperventilation and carpopedal spasm, on physical examination chvostek sign and Trousseau sign is positive she was managed under hypocalcaemia with giving calcium gluconate. Lab test shows decrease free calcium .she doesn’t have any past history of hypocalcaemia. So my question is why she developed hypocalcaemia?

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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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