Hypocalcemia in Patients with Acute Pancreatitis: A Putative Role for Systemic Endotoxin Exposure
- 1 April 2003
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pancreas
- Vol. 26 (3), 213-217
- https://doi.org/10.1097/00006676-200304000-00001
Abstract
Hypocalcemia is not uncommon during acute pancreatitis and is associated with a poor outcome. Whilst the mechanisms responsible for its development remain unclear, there is evidence to implicate endotoxemia in other models of sepsis. To investigate the potential role of systemic endotoxin exposure in the development of hypocalcemia in patients with acute pancreatitis. Adjusted serum calcium was measured daily, and the lowest value within 72 hours of admission for acute pancreatitis was determined. Serum endotoxin and both IgG and IgM antiendotoxin core antibodies (EndoCAbs) were measured on admission. Attacks were classified as mild (n = 51) or severe (n = 21) according to the criteria of the Atlanta International Symposium of 1992. Hypocalcemia was significantly more frequent (86% versus 39%, p < 0.001) and reached significantly lower levels during severe attacks than during mild attacks (median [interquartile range], 2.06 [1.78–2.17] mmol/L, versus 2.23 [2.15–2.30] mmol/L;p < 0.001). Endotoxemia was present in a significantly greater proportion of patients with severe disease (71% versus 41%;p = 0.037), and serum IgM and IgG EndoCAbs were significantly depleted during severe attacks in comparison with mild attacks (p = 0.007 and p = 0.039, respectively). A negative and significant correlation was observed between endotoxemia and both the admission and lowest serum concentrations of adjusted calcium (r = −0.424 and p = 0.022;r = −0.383 and p = 0.037, respectively), and the latter correlated significantly with serum IgG EndoCAb concentrations (r = 0.251;p = 0.036). Systemic endotoxin exposure appears to play a significant role in the development of hypocalcemia in patients with acute pancreatitis.Keywords
This publication has 37 references indexed in Scilit:
- Effects of lipopolysaccharide on TNF-α production, hepatic NOS2 activity, and hepatic toxicity in rats with cirrhosisJournal of Hepatology, 2000
- Disordered calcium homeostasis of sepsis: association with calcitonin precursorsEuropean Journal of Clinical Investigation, 2000
- Leukocyte Modulation Inhibits Endotoxin-Induced Disruption of Intracellular Calcium HomeostasisThe Journal of Trauma and Acute Care Surgery, 1995
- Circulating intact parathyroid hormone levels in acute pancreatitisBritish Journal of Surgery, 1994
- Human sepsis increases lymphocyte intracellular calciumCritical Care Medicine, 1993
- Intraperitoneal free fatty acids induce severe hypocalcemia in rats: A model for the hypocalcemia of pancreatitisJournal of Bone and Mineral Research, 1990
- Calcium administration increases the mortality of endotoxic shock in ratsCritical Care Medicine, 1989
- Endotoxaemia and acute pancreatitis: correlation between the severity of the disease and the anti-enterobacterial common antigen antibody titre.Gut, 1984
- Parathyroid hormone and calcium homeostasis in acute pancreatitisBritish Journal of Surgery, 1978
- Serum ionized calcium in acute pancreatitisBritish Journal of Surgery, 1977