Dear All,
A 53-year old woman presented with abdominal pain, confusion and reduced consciousness, her admission bloods showed high serum amylase of 1183 IU/L and high adjusted calcium of 3.75 mmol/L. Abdominal CT confirmed acute pancreatitis and biliary tree and gall bladder were normal. The patient was managed with i.v fluids mainly and it was presumed that this was a case of hypercalcaemia induced acute pancreatitis. No anti-resorptive therapy was given. PTH was appropriately suppressed at < 0.1 pmol/L and vitamin D was low at 38 nmol/L. Threre was no paraproteinaemia and urinary BJP was negative. Past medical history of depression and was taking citalopram, hydroxyzine , HRT and calcichew tablets. A CT of chest, abdomen & pelvis has shown no gross pathology apart from changes of acute pancreatitis. The serum calcium has fallen gradually over the follwing week to 2.15 mmol/L and has recovered well from
the acute pancreatitis episode.
I know that acute pancreatitis can precipitate hypocalcaemia, but could this explain the recovery of hypercalcaemic crisis without specific therapy? So far we have failed to find out the cause of her initial hypercalcaemia.
Any suggestion is welcome.
thanks
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
