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Hypercalcemia in the ED: prevalence, etiology, and outcome

Published:December 13, 2012DOI:https://doi.org/10.1016/j.ajem.2012.11.010

      Abstract

      Purposes

      The aim of the study was to describe the prevalence, demographic, and clinical characteristics and etiologies of hypercalcemia in emergency department patients.

      Basic procedures

      In this retrospective cross-sectional descriptive study, all patients admitted between April 1, 2008, and March 31, 2011, to the emergency department of Inselspital, University Hospital Bern, were screened for the presence of hypercalcemia, defined as a serum calcium exceeding 2.55 mmol/L after correction for serum albumin. Demographic, laboratory, and outcome data were gathered. A detailed medical record review was performed to identify causes of hypercalcemia.

      Main findings

      During the study period, 14 984 patients (19% of all admitted patients) received a measurement of serum calcium. Of these, 116 patients (0.7%) presented with hypercalcemia. Median serum calcium was 2.72 mmol/L (first quartile, 2.64; third quartile, 2.88), with 4.3 mmol/L being the maximum serum calcium value observed. Underlying malignancy in 44% of patients and hyperparathyroidism in 20% (12% secondary and 8% primary) were the leading causes of hypercalcemia. Twenty-six percent of patients presented with symptomatic hypercalcemia. Weakness was the most common symptom of hypercalcemia, followed by nausea and disorientation.

      Principal conclusions

      Hypercalcemia is a rare but harmful electrolyte disorder in emergency department patients. Unspecific symptoms such as a change in mental state, weakness, or gastrointestinal symptoms should prompt physicians to order serum calcium measurements, at least in patients with known malignancy or renal insufficiency.
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      References

        • Arora S.
        • Cheng D.
        • Wyler B.
        • Menchine M.
        Prevalence of hypokalemia in ED patients with diabetic ketoacidosis.
        Am J Emerg Med. 2012; 30: 481-484
        • Arampatzis S.
        • Exadaktylos A.
        • Buhl D.
        • Zimmermann H.
        • Lindner G.
        Dysnatraemias in the emergency room: undetected, untreated, unknown?.
        Wien Klin Wochenschr. 2012; 124: 181-183
        • Lee C.T.
        • Yang C.C.
        • Lam K.K.
        • Kung C.T.
        • Tsai C.J.
        • Chen H.C.
        Hypercalcemia in the emergency department.
        Am J Med Sci. 2006; 331: 119-123
        • Shek C.C.
        • Natkunam A.
        • Tsang V.
        • Cockram C.S.
        • Swaminathan R.
        Incidence, causes and mechanism of hypercalcaemia in a hospital population in Hong Kong.
        Q J Med. 1990; 77: 1277-1285
        • Fisken R.A.
        • Heath D.A.
        • Somers S.
        • Bold A.M.
        Hypercalcaemia in hospital patients. Clinical and diagnostic aspects.
        Lancet. 1981; 1: 202-207
        • Bushinsky D.A.
        • Monk R.D.
        Electrolyte quintet: calcium.
        Lancet. 1998; 352: 306-311
        • Figge J.
        • Jabor A.
        • Kazda A.
        • Fencl V.
        Anion gap and hypoalbuminemia.
        Crit Care Med. 1998; 26: 1807-1810
        • Dent D.M.
        • Miller J.L.
        • Klaff L.
        • Barron J.
        The incidence and causes of hypercalcaemia.
        Postgrad Med J. 1987; 63: 745-750
        • McLellan G.
        • Baird C.W.
        • Melick R.
        Hypercalcaemia in an Australian hospital adult population.
        Med J Aust. 1968; 2: 354-356
        • Chou F.F.
        • Sheen-Chen S.M.
        • Leong C.P.
        Neuromuscular recovery after parathyroidectomy in primary hyperparathyroidism.
        Surgery. 1995; 117: 18-25
      1. Shane E. Clinical manifestations of hypercalcemia. UpToDate, online 2012; 20.9.

        • Diamond T.H.
        • Botha J.R.
        • Vermaak W.J.
        • Kalk W.J.
        Hypercalcaemia in the Johannesburg Hospital. Differential diagnosis and physician awareness of primary hyperparathyroidism.
        S Afr Med J. 1987; 72: 113-115
        • Rajathurai A.
        • Cove-Smith R.
        Hypercalcaemia in Cleveland: a hospital-based survey.
        J R Soc Med. 1984; 77: 742-746
      2. Shane E. Etiology of hypercalcemia. UpToDate, online 2012; 20.9.

        • Greaves I.
        • Grant A.J.
        • Heath D.A.
        • Michael J.
        • Adu D.
        Hypercalcaemia: changing causes over the past 10 years.
        BMJ. 1992; 304: 1284