STUDY OF SERUM CALCIUM AND SERUM AMYLASE IN PROGNOSIS OF ACUTE PANCREATITIS AND ITS MANAGEMENT

Background: Acute pancreatitis is one of the most common acute non-surgical emergenciesgetting admitted under general surgery unit. These patients generally at the time of presentation are very fragile and need adequate resuscitation which if failed can lead to SIRS which can eventually lead to MODS. Rise in serum amylase and fall in serum calcium are important diagnostic tools and their relationship can help in predicting better prognostic results in patients with acute pancreatitis

Objective: This study is done to:1.to study serum amylase levels in patients of acute pancreatitis at the admission and at 48 hours2.to study serum calcium levels at the time of admission3.to find out relationship, if any, between serum calcium and serum amylase in relation to prognosis compared by hospital stay in patients of acute pancreatitis4.to study total hospital stay in patients of acute pancreatitis

Methods: this hospital based retrospective open case study includes patients admitted in a tertiary hospital at Navi Mumbai from May 2007 to September 2009. Due clearance was taken for the study by ethics committee of the medical college. The patients admitted from opd or emergency room were explained about their involvement in the study and due consent was taken. Initial assessment and resuscitation were done by on call surgery team. Patient was then shifted to ward or surgical icu based on patients’ condition on admission. complete blood profile and radiological assessment were done. patients progress was monitored from the time of admission till discharge. Patients on admission serum calcium and serum amylase were sent. Amylase was repeated at 48 hours from admission. Their values are relationship with each other were compared

Results: In our study of 60 patients,55 patients had serum amylase level above normal limits. At 48 hrs, in 32 patients, serum amylase level fell to normal limits.in rest 21patients, levels were reduced but was still above normal limits.in 2 patients, serum amylase were further elevated.

In this study, 16 patients had calcium level less than 8.4. 1 patient had calcium level more than 10.4. Rest patients had serum calcium level within normal range

Conclusion: In our study in 60 patients of acute pancreatitis, serum amylase levels were raised at admission and was an important diagnostic tool for diagnosis of acute pancreatitis. The serum amylase levels significantly dropped after 48 hours. Serum calcium levels fluctuated marginally within normal limits and dropped just below normal in some cases. however, serum calcium was not important as a diagnostic tool

Serum amylase levels at admission corelated well with hospital stay and relationship was direct and linear. higher serum amylase levels were associated with longer hospital stay and lower levels with lesser stay. Serum amylase levels declined in most cases at 48 hours.The serum calcium levels also corelated well with hospital stay and relationship was linear and inverse. lower levels were associated with longer hospital stay and higher / normal levels with shorter hospital stay.