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Antacid-induced acute pancreatitis.

The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists (2013-04-05)
Diane Nykamp, Emily J Kraus
ABSTRACT

To report a case of acute pancreatitis associated with the administration of high doses of over-the-counter (OTC) antacids containing calcium carbonate. An acute care 276-bed community hospital. In this case report, a 68-year-old male was admitted to the hospital for nausea, vomiting, and stomach pain. Patient reported taking 15-20 OTC calcium carbonate (4.5-6.0 g elemental calcium) tablets for four to five days prior to admission. Patient's calcium level upon admission was 18.5 mg/dL. Laboratory values of amylase and lipase peaked at 2,768 U/L and 7,091 U/L, respectively. An abdominal computed tomography confirmed acute pancreatitis. For a period of 45 days, treatment in the intensive care unit for acute pancreatitis and latter for necrotizing pancreatitis was conducted. This case study supports an association between hypercalcemia and pancreatitis in patients who take greater than recommended dosages of calcium-containing antacids. OTC antacids are popular, but can cause serious adverse events when not used as directed.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Lipase from Mucor miehei, powder, slightly brown, ~1 U/mg
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Lipase from Candida rugosa, lyophilized, powder (fine), 15-25 U/mg
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Lipase from Rhizopus oryzae, powder (fine), ~10 U/mg
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Lipase from Candida rugosa, powder, yellow-brown, ≥2 U/mg
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Lipase from Aspergillus oryzae, lyophilized, powder, white, ~50 U/mg
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Lipase from Mucor miehei, lyophilized powder, ≥4,000 units/mg solid (using olive oil)
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Lipase from porcine pancreas, Type II, ≥125 units/mg protein (using olive oil (30 min incubation)), 30-90 units/mg protein (using triacetin)
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Lipase from porcine pancreas, Type VI-S, ≥20,000 units/mg protein, lyophilized powder
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Lipase from wheat germ, Type I, lyophilized powder, 5-15 units/mg solid
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Lipase acrylic resin, ≥5,000 U/g, recombinant, expressed in Aspergillus niger
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Lipase from Aspergillus oryzae, solution, ≥100,000 U/g, white, beige
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Lipase from Aspergillus oryzae, ≥20,000 U/g
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Lipase from Pseudomonas sp., Type XIII, lyophilized powder, ≥15 units/mg solid
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Marble, CP
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Lipase from Candida rugosa, Type VII, ≥700 unit/mg solid
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Lipase from Candida rugosa, lyophilized powder, ≥40,000 units/mg protein
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Lipase from Rhizopus niveus, powder (fine), ≥1.5 U/mg
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Lipase from Candida sp., recombinant, expressed in Aspergillus niger
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Calcium carbonate, 99.999% trace metals basis
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Supelco
Calcium carbonate, reference material for titrimetry, certified by BAM, ≥99.5%
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Lipase B Candida antarctica, recombinant from Aspergillus oryzae, powder, beige, ~9 U/mg
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Lipase A Candida antarctica, recombinant from Aspergillus oryzae, powder, beige, ~2 U/mg
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Lipase from Pseudomonas cepacia, powder, light beige, ≥30 U/mg
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