Physical examination findings include abdominal tenderness

A 28-year-old female is hospitalized 1 day after an endoscopic retrograde cholangiopancreatography (ERCP) because of vomiting, weakness, and severe abdominal pain. Physical examination findings include abdominal tenderness and diminished bowel sounds. A CT scan demonstrates fluid around the pancreas. Serum levels of which of the following are likely to be low in this patient?



The patient is hospitalized 1 day post-ERCP with symptoms and imaging suggestive of acute pancreatitis. In acute pancreatitis, serum amylase levels are elevated and free digested fats may bind with serum calcium, causing hypocalcemia.

ERCP is the third most common cause of acute pancreatitis, following alcohol ingestion and gallstones. Acute pancreatitis symptoms include nausea/vomiting, severe epigastric pain, weakness, low fever, shock, and tetany due to hypocalcemia. Physical exam findings include abdominal tenderness, diminished bowel sounds, and jaundice (rare). Treatment includes pain control and acute management (IV fluids, bowel rest, NG decompression, antibiotics, and oxygen).

Illustration A shows an axial CT of acute pancreatitis. Extensive fluid collections surround the pancreas.