title: Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis.
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).
  
  
  CONCLUSIONS
  Presence of hypocalcemic tetany in AP patients bears a poor prognosis and is associated with increased mortality.
authors.affiliation: Department of Gastroenterology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak K. Bhasin), India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Chhabra
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak K. Bhasin), India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Bhasin
keywords: Hypocalcemia; acute pancreatitis; tetany