SAT-747 Acute Pancreatitis and Profound Hypocalcemia: Recognizing Spontaneous Trousseau’s Sign as a Life-Threatening Indicator

Abstract Disclosure: M. Lopez Baez: None. A. Szeinfeld: None. C. Sanchez Perez: None. Y. Benitez: None. S. Hanson-Leal: None. Hypocalcemia is a common finding in acute pancreatitis, with prevalence rates ranging from 15% to 88% in critically ill patients, depending on the setting and diagnostic criteria used. In this case, a 46-year-old female with a history of mixed hyperlipidemia and recurrent pancreatitis presented with left flank pain. Acute pancreatitis was confirmed by an elevated lipase level (3811 U/L) and evidence of pancreatic inflammation on contrast-enhanced CT. Triglycerides were markedly elevated (>1575 mg/dL, exceeding assay limits), and corrected calcium was low at 7.7 mg/dL. Within hours, she developed perioral numbness and tingling in her extremities. During a subsequent clinical assessment, a spontaneous Trousseau’s sign was observed—carpopedal spasm occurring without blood pressure cuff inflation—raising immediate suspicion of worsening hypocalcemia. Arterial blood gas analysis confirmed a profoundly reduced ionized calcium level of 0.77 mmol/L.Recognizing the severity of the metabolic disturbance, the patient was promptly transferred to the intensive care unit for emergent intravenous calcium replacement and an insulin infusion for hypertriglyceridemia management. The presence of spontaneous Trousseau’s sign served as a crucial bedside indicator of life-threatening hypocalcemia, allowing for timely intervention and prevention of further complications.This case underscores the importance of early recognition of severe hypocalcemia in acute pancreatitis. The observation of Trousseau’s sign without external provocation highlights its potential as a critical clinical finding warranting urgent correction. A multidisciplinary approach, including endocrinology and critical care teams, was pivotal in ensuring a favorable outcome. Increased awareness of spontaneous Trousseau’s sign in patients with pancreatitis may improve timely diagnosis and management, reducing morbidity and improving prognosis. Presentation: Saturday, July 12, 2025