Management of Hypocalcemia in Acute Pancreatitis

Pathophysiology and Prevalence

Hypocalcemia occurs in up to 25% of patients with severe acute pancreatitis 1
The American Society for Parenteral and Enteral Nutrition recommends considering the mechanism of hypocalcemia, which involves circulating lipase and phospholipase cleaving triglycerides, raising serum free fatty acids that bind to calcium, forming insoluble calcium soaps in areas of fat necrosis 2
Intravascular sequestration of calcium occurs through FFA-albumin complexes, resulting in hypocalcemia, according to the European Society for Clinical Nutrition and Metabolism 2
Serum calcium levels below 2 mmol/L are considered a negative prognostic factor in acute pancreatitis, as stated by the Society of Critical Care Medicine 2

The World Journal of Emergency Surgery recommends enteral nutrition to prevent gut failure and infectious complications in patients with acute pancreatitis and hypocalcemia 3
Total parenteral nutrition should be avoided, but partial parenteral nutrition can be considered if enteral route is not completely tolerated, as suggested by the American Society for Parenteral and Enteral Nutrition 3
Both gastric and jejunal feeding can be delivered safely, according to the European Society for Clinical Nutrition and Metabolism 3