bariluis
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A 60-year-old man is seen in the emergency room and is diagnosed as having acute pancreatitis. Which one of the following would suggest more severe illness?
1) serum amylase level > 2000
2) hyperglycemia and glycosuria
3) high urinary amylase level
4) serum lipase level > 20,000
5) decreased serum calcium level
2 or 5?
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| drnadeemusmani
Forum Senior
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i think decreased calcium
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| paheli
It'sAllAboutGoodKarma
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Yep, I too think 5.
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| arlete
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It depends on how long the disease has been going on, doesn't it? Initially, 2, and then 5. So the question should have given the onset of symptoms, I think.
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| tompat
Forum Elite
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i think its 5.
hypocalcemia can occure in the setting of acute pancreatitis and it is due to excess saponification in the pancreatic tissue. when there is excess release of pancreatic lipase, it acts in the surrounding fatty tissue which then are free to interact with serum calcium and form soaps/ ca compounds.
so the hypocalcemia due to poor absorption would be compensated by PTH release. but in acute condition PTH fails to show action in less time.
why not hyperglycemia here cause i think it is more vague as any acute stressful illness would give rise to hyperglcemia.
do correct me if i m wrong.
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| ngaybinhyen
Forum Guru
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HYPERGLYCEMIA
TABLE 3–3 Ranson's Criteria
Admission Criteria (GA LAW) Initial 48 Hours Criteria (C HOBBS) Mortality
Glucose >200 mg/dL Calcium <8 mg/dL
Decrease in Hematocrit >10% <3 criteria—1%
Age >55 years Pao2 <60 mm Hg 3–4 criteria—15%
LDH >350 BUN increase >8 mg/dL 5–6 criteria—40%
AST >250 Base deficit >4 mg/dL >7 criteria—100%
WBC >16,000 Fluid sequestration >6 L
On admission, the patient already shows up with high glucose level. Low Ca level may imply a rough course but not included as a risk factor.
Regarding the mechanism of high clucose level, I'm not sure it is from stress. I have to look up again, but think it has something to do with beta cell of the lovely pancreas. Anybody, please help!
-t.
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| ngaybinhyen
Forum Guru
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 Sorry for the mess
Here are the criteria
At admission:
age in years >55years
white blood cell count > 16000/mcL
blood glucose > 11 mmol/L (>200 mg/dL)
serum AST > 250 IU/L
serum LDH > 350 IU/L
After 48 hours:
Calcium (serium calcium < 2.0 mmol/L (<8.0 mg/dL)
Haematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit > 4Meq/L
Sequestration of fluids > 6L
* Score 0 to 2 : 2% mortality
* Score 3 to 4 : 15% mortality
* Score 5 to 6 : 40% mortality
* Score 7 to 8 : 100% mortality
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| arlete
Forum Fanatic
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That's why I thought the timing should have been given...  I still don't know if it's 2 or 5.
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| amnesia
Forum Newbie
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thanks ngaybinhyen...
regarding the cause of hyperglycemia....i guess it is simply due to decrease insulin release .....remember ..the pancreas is the source of insulin ...so when it is sick there would b no insulin..
regarding the cause of high BUN..it is due to hypovolemia due to third space sequestration of body fluids.
regarding low PO2..it is due vasoactive mediators released from the pancreas and exert their effect on the lung >>causing pulmonary edema.
Hypocalcemia is due to binding of calcium to the realesd fatty acids >>forming calcium soap..
i agree e alrete...the q is lacking the time of onset..
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| tompat
Forum Elite
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what i am saying is hypocalcemia and hyperglyemia can be seen in acute pancreatitis, so there is no question of time duration to be given over here.
u wud hardly see hypocalcemia in chronic pancreatitis i speculate so.
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| ngaybinhyen
Forum Guru
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I thought the scenario in the ER means "at admission"
Please comment
-t.
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| ngaybinhyen
Forum Guru
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Hyperglycemia in this patient may not indicate a stress status as it is significant with glycosuria. It has to pass the kidney threshold for glucose.
Anybody please correct.
-t
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| bariluis
Forum Junior
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Thanks for all your comments. This is a MCQ question and I am still nto confident about the answer. Maybe more severe means also a late case (like after 48 hours)?
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| ngaybinhyen
Forum Guru
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So what's the answer, barilius?
-t.
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| WaqasQureshi
Forum Senior
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decreased calcium level. Directly related with severity. Also mentioned in ranson score. Nothing else is mentioned in ranson score. 
it is statistically related issue. dont go into the REASONS
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| arlete
Forum Fanatic
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Hyperglycemia is there too...
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