Serial measurements of serum amylase, lipase and ionized calcium were made in a prospective study of 17 patients with acute pancreatitis. The mean serum ionized calcium was significantly below the normal range for the first 24 h and had returned to normal after 48 h. There was no correlation between serum ionized calcium and paired calcium corrected for albumin during the first 36 h of the study, but they were correlated for the remainder of the investigation. Serum lipase and ionized calcium levels were just significantly correlated over the first 3 days (r = -0.44; t = 2.3; P less than 0.05; d.f. 22), but failed to reach correlation over the whole period of study (r = -0.34; t = 2.0; d.f. 31). These data establish a significant drop in directly measured ionized calcium early in an attack of pancreatitis, which is not seen in the paired corrected calcium values. Furthermore, the drop is correlated with serum lipase, although this is weak and other factors must be involved in the hypocalcaemia.