A 47 year old alcoholic presents with acute upper left abdominal pain with pain on palpation. The pain is referred to his back. Lab results reveal a low serum calcium level. His hypocalcemia probably reflects which of the following?

The patient most likely has acute pancreatitis, which is commonly caused by either alcoholism or impaction of a small gallstone in the common bile duct. Acute pancreatitis causes the release of many digestive enzyme precursors, which are then conveed to the active form in the damaged tissues. These enzymes degrade the adipose tissue around the pancreatic lobules, producing enzymatic fat necrosis. As pa of this process, many free fatty acids are produced that can bind as soaps with extracellular calcium in chemical equilibrium with serum calcium. This will often cause a significant decrease in serum calcium levels. Caseous necrosis is seen in granulomata produced by infection with M. tuberculosis. Coagulative necrosis preserves the outlines of cells in affected tissue. This common type of necrosis is seen in the hea following an infarct. Gangrenous necrosis is massive necrosis associated with loss of vascular supply, and is generally accompanied by bacterial infection. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 1. Cellular Pathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.