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Hypercalcemia in the emergency department.

Chien-Te Lee1, Chih-Chao Yang, King-Kwan Lam

  • 1Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taiwan.

The American Journal of the Medical Sciences
|March 16, 2006
PubMed
Summary

Severe hypercalcemia is common and dangerous in the emergency department. Malignancy and uremia are frequent causes, and elevated calcium levels independently predict mortality, necessitating prompt treatment.

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Area of Science:

  • Emergency Medicine
  • Nephrology
  • Oncology

Background:

  • Severe hypercalcemia poses a life-threatening risk.
  • The incidence, causes, and outcomes of hypercalcemia in the emergency department (ED) are not well-established.
  • This study aimed to determine hypercalcemia's incidence, causes, and impact on renal function and survival in the ED.

Purpose of the Study:

  • To investigate the incidence and underlying causes of hypercalcemia in the emergency department.
  • To assess the impact of hypercalcemia on renal function.
  • To determine the factors associated with mortality in hypercalcemic patients.

Main Methods:

  • A retrospective study analyzed patients with hypercalcemia (serum total calcium > 10.3 mg/dL) in the ED over one year.

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  • Data collected included serum calcium levels, underlying causes, renal function, and mortality.
  • Logistic analysis was used to identify independent risk factors for mortality.

    • Main Results:

    • Hypercalcemia was found in 7.5% of ED patients (321/4293), with most cases being mild (70.7% < 12.0 g/dL).
    • Malignancy (36.4%) and uremia (32.4%) were the leading causes.
    • Only 23.4% had normal renal function. The overall mortality rate was 23.1%, with higher calcium and lower hemoglobin levels, male gender, and malignancy being significant predictors of death.

    Conclusions:

    • Hypercalcemia is a frequent and life-threatening condition in the ED.
    • Routine serum calcium determination and prompt initiation of therapy are recommended for high-risk patients.
    • Serum calcium and hemoglobin levels are independent risk factors for mortality in hypercalcemic patients.