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. 2016 Apr-Jun;29(2):214-20.
doi: 10.20524/aog.2016.0015.

Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis

Puneet Chhabra  1 , Surinder S Rana  2 , Vishal Sharma  2 , Ravi Sharma  2 , Deepak K Bhasin  1
Affiliations

Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis

Puneet Chhabra et al. Ann Gastroenterol. 2016 Apr-Jun.

Abstract

Background: Hypocalcemia is a marker of poor prognosis in acute pancreatitis (AP) but the prognostic significance of hypocalcemic tetany in patients with AP has not been studied. We aimed to determine the prognostic significance of hypocalcemic tetany in patients with AP.

Methods: Consecutive patients of AP who presented within 7 days of symptoms were included. Serum calcium levels were measured on admission and the patients were divided into two groups based on the presence (group 1) or absence of hypocalcemia (group 2). Chvostek and Trousseau signs were sought in all patients with hypocalcemia and the outcome measures were compared between patients with normocalcemia, asymptomatic and symptomatic hypocalcemia (tetany). The outcome parameters assessed were persistent organ failure (POF), need for intervention, and mortality.

Results: Of 105 patients (53 male; mean age 37.34±12.62 years), 37 (35.2%) had hypocalcemia (group 1) and 68 (64.8%) had normal corrected serum calcium levels (group 2). Patients with hypocalcemia had significantly higher frequency of POF, mortality and need for intervention (P<0.05). Twelve of 37 (32.4%) patients with hypocalcemia had tetany. Patients with tetany had significantly lower serum corrected calcium and ionized calcium levels compared with patients with asymptomatic hypocalcemia (P<0.05). Patients with tetany had significantly higher mortality rates compared with patients with asymptomatic hypocalcemia (100% vs. 8%; P=0.00001) as well as POF (100% vs. 32%; P=0.000006).

Conclusion: Presence of hypocalcemic tetany in AP patients bears a poor prognosis and is associated with increased mortality.

Keywords: Hypocalcemia; acute pancreatitis; tetany.

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Conflict of interest statement

Conflict of Interest: This paper was presented at the annual meeting of American Pancreatology Association Held at San Diego 2015

Figures

Figure 1
Figure 1
(A) Trousseau sign in a patient with acute pancreatitis. This patient had tetany on the day of admission in emergency and succumbed to respiratory failure within 24 h. (B) Trousseau sign in a 30/f who developed tetany on day 5 of onset of symptoms. (C) Carpal spasm in a patient who developed tetany within 72 h of onset of symptoms
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