A 45-year-old man is admitted with acute pancreatitis. On day 2, his serum calcium is 6.8 mg/dL (corrected for albumin). He is asymptomatic. Which statement regarding calcium replacement is correct?
- A Asymptomatic hypocalcaemia should be treated immediately with IV calcium gluconate to prevent tetany
- B Hypocalcaemia in acute pancreatitis is usually due to calcium皂formation in retroperitoneal fat and ionized calcium may be normal ✓
- C IV calcium chloride is preferred over calcium gluconate because it provides more elemental calcium
- D Oral calcium carbonate is the first-line treatment for hypocalcaemia in acute pancreatitis
Correct answer: B. Hypocalcaemia in acute pancreatitis is usually due to calcium皂formation in retroperitoneal fat and ionized calcium may be normal
Explanation
In acute pancreatitis, hypocalcaemia occurs due to saponification of calcium in necrotic fat, but ionized calcium may be normal. Asymptomatic patients do not require urgent IV calcium replacement, as it may worsen pancreatic injury. IV calcium gluconate is preferred over calcium chloride for peripheral administration because chloride is more irritating to veins. Oral calcium is not appropriate for acute management in a patient who may have ileus.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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