We were very grateful and proud with the very interesting commentaries and suggestions of Professor Kargi et al. in their commentary letter: ‘The pathogenesis of acute pancreatitis in patients with SCI’.
In our randomized controlled trial prospective study, we really measured, following Ranson’s Criterias (RCs) in acute pancreatitis (AP) on admissions, the serum levels of the following:
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Glucose >200 mg dl−1 (>11 mmol l−1)
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Lactate dehydogenase >350 IU l−1
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Serum glutamic oxaloacetic transaminase (aspartate aminotransferase) >250 IU l−1
Following the evaluation of the patients with spinal cord injury (SCI) after 48 h of admission, we solicited the following:
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Fall in hematocrit >10%
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Increase in blood urea nitrogen to >5 mg dl−1 (>1.98 mmol l−1)
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Calcium <8 mg dl−1 (<2 mmol l−1)
Great number of the patients with pancreatitis (78%) presented two or three of each blood test determinates in RCs including elevation of serum level of calcium.1
Hypertriglyceridemia is a very important cause of AP; however, when levels are >1000 mg dl−1 (11.3 mmol l−1 ), and it is associated with this disease in 1–4% of cases.1, 2, 3 A large proportion of patients (sample) in our study comprised younger subjects; therefore, high levels of triglycerides are very rare.3
Maybe, with the use of analyses of triglyceride blood test, as Professor Kargi et al. suggested, and more frequent analyses of pancreatic serum enzymes (amylases and lipases) in future studies, the rates of incidences of AP in SCI are bound to increase.
References
Pirolla EH, de Barros Filho TE, Godoy-Santos AL, Fregni F . Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury: a prospective study. Spinal cord 2014; 52: 817–820.
Yuan G, Al-Shali KZ, Hegele RA . Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007; 176: 1113–1120.
Berglund L, Brunzell JD, Goldberg AC et al. Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2012; 97: 2969–2989.
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Pirolla, E., de Barros Filho, T., Godoy-Santos, A. et al. Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury: a prospective study. Spinal Cord 53, 495 (2015). https://doi.org/10.1038/sc.2015.7
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DOI: https://doi.org/10.1038/sc.2015.7
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