Hepatobiliary and pancreatic surgery: hypocalcaemia in acute pancreatitis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: hypocalcaemia in acute pancreatitis

Sample item

On day 3 of severe acute pancreatitis, a patient has a serum calcium of 1.8 mmol/L despite normal albumin. Which mechanism contributes to this finding?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Saponification of calcium by fatty acids in fat necrosis

Released lipase digests fat in the peritoneum and retroperitoneum, and the free fatty acids bind calcium to form soaps. Hypocalcaemia in acute pancreatitis therefore reflects the extent of fat necrosis and predicts severity.

Option by option

  • A. Loss of calcium in the urine from hypercalciuria

    Urinary calcium loss is not a feature.

  • B. Saponification of calcium by fatty acids in fat necrosis (correct)

    Correct. Calcium soaps form in areas of fat necrosis and lower serum calcium.

  • C. Failure of vitamin D hydroxylation in the kidney

    Vitamin D activation is not the main mechanism.

  • D. Excess parathyroid hormone secretion

    Parathyroid hormone is usually appropriately raised, not excessive.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Saponification of calcium by fatty acids in fat necrosis. Released lipase digests fat in the peritoneum and retroperitoneum, and the free fatty acids bind calcium to form soaps.

Why is "Loss of calcium in the urine from hypercalciuria" not the answer?

Urinary calcium loss is not a feature.

Why is "Failure of vitamin D hydroxylation in the kidney" not the answer?

Vitamin D activation is not the main mechanism.

Why is "Excess parathyroid hormone secretion" not the answer?

Parathyroid hormone is usually appropriately raised, not excessive.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: hypocalcaemia in acute pancreatitis in General Surgery. Hypocalcaemia in acute pancreatitis therefore reflects the extent of fat necrosis and predicts severity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: hypocalcaemia in acute pancreatitis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.