To the Editor.—
The recent interesting report of Gafter et al (235:2004, 1976) on pancreatitis secondary to the hypercalcemia of metastatic malignancy brings to mind an instructive case seen by us a short while ago.A stuporous 70-year-old patient had a serum calcium level of 15.8 mg/100 ml; phosphorus, 5.1 mg/100 ml; creatinine, 2.4 mg/100 ml; and clinical signs of acute pancreatitis. A bone scan and abdominal x-ray films showed no bony abnormalities. The calcium level declined only mildly over two days to 13 mg/100 ml, with hydration, furosemide (Lasix) and steroid therapy and phosphate via nasogastric tube. Severe worsening of the renal insufficiency developed, with an elevation of phosphorus to 8.3 mg/100 ml when the calcium level was 13 mg/100 ml. Since the patient remained seriously ill and stuporous, it was elected to administer calcitonin (Calcimar) in two intramuscular doses of 100 Medical Research Council units each, six hours
Goldberg LD, Herschmann EM. Hypercalcemia and Pancreatitis. JAMA. 1976;236(12):1352. doi:10.1001/jama.1976.03270130016009
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