An unusual case of severe hypercalcemia: as dehydrated as a bone

Acharya, Roshan; Winters, D; Rowe, Cameron; Buckley, Nathan; Kafle, Smita; Chhetri, Bhaskar

doi:10.1080/20009666.2020.1851859

Cited by 8 publications

(1 citation statement)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unfortunately, although hypercalcemia is frequently encountered in daily clinical practice and despite the fact that it has potentially dangerous consequences for the patient, there is a scarcity of data from larger case series. In several case reports, severe hypercalcemia was associated with dihydrotachysterol intoxication [19], the combination of vitamin A and hydrochlorothiazide [20], hematologic malignancies [21], sarcoidosis [22] and severe dehydration [23].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study

Ravioli¹,

Lafranchi²,

Exadaktylos³

et al. 2023

Swiss Med Wkly

View full text Add to dashboard Cite

AIMS OF THE STUDY: To investigate the prevalence of hypercalcemia (>2.60 mmol/l) and severe hypercalcemia (≥2.80 mmol/l) on admission. Symptoms, causes, course of serum calcium, treatment and outcome of severe hypercalcemia were evaluated and compared to historical data from previous studies. METHODS: In this retrospective cohort study, all patients presenting to the interdisciplinary emergency department of the Buergerspital Solothurn between 01 January 2017 and 31 December 2020 with measurements of serum calcium were included. Chart reviews were performed for patients with calcium ≥2.80 mmol/l to assess clinical presentation, course of disease and treatment for severe hypercalcemia. RESULTS: Of 31,963 tested patients, 869 patients (2.7%) had hypercalcemia on the admission, of which 161 had severe hypercalcemia. Non-albumin corrected calcium was 3.07 (0.32) while albumin corrected calcium was 3.34 (0.44). Calcium was higher in patients with malignancy-related hypercalcemia (3.18 [0.34] versus 3.00 [0.3], p <0.001). Neuropsychiatric (35%) and gastrointestinal (24%) were the leading symptoms. Malignancy was the most common identifiable cause of hypercalcemia (40%), with lung cancer (20%), multiple myeloma (14%) and renal cell carcinoma (11%) being the main cancer types. 36% of patients with severe hypercalcemia took calcium supplements. Bisphosphonate treatment was an independent predictor of a fall in calcium until day 5 (regression coefficient: –0.404, standard error 0.11, p <0.001). Hypercalcemia was not mentioned in the final discharge report in 38% of cases. CONCLUSION: Severe hypercalcemia is common and malignancy-related in almost half of the cases. Neuropsychiatric and gastrointestinal symptoms were most prevalent. Awareness of hypercalcemia, particularly in cancer patients and those with known triggering factors, should be raised in order to identify and treat this harmful disorder early.

show abstract

Section: Introductionmentioning

confidence: 99%

Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study

Ravioli¹,

Lafranchi²,

Exadaktylos³

et al. 2023

Swiss Med Wkly

View full text Add to dashboard Cite

show abstract

Imaging Pitfalls, When We Should Trust Our Touch

Zoubi

Hijazi

Kassem

2023

The American Journal of Medicine

View full text Add to dashboard Cite

Variable Power Functional Dilution Adjustment of Spot Urine

Carmine¹

2023

Preprint

View full text Add to dashboard Cite

Background Dilution adjustment of spot-urinary biomarkers by conventional creatinine correction (CCRC) remains controversial. Apart from unaccounted confounders like age, sex, muscle mass, or diet, the misperception of constant mass ratios between analyte and creatinine (uCR) over a wide hydration range entails deceptive creatinine correction errors (CRCE), foremost at both ends of the uCR-spectrum. Mitigating CRCE by restricting uCR-ranges to 0.3(0.4)-3 g/L generates high numbers of sample rejects and allows for misleading fluctuations within presumably tolerable uCR-ranges. Methods The CRCE for exemplary total weight Arsenic (TWuAs) was analyzed in a large set of n= 5,599 unselected spot urine samples. After confining data to 14 - 80 years, uncorrected arsenic (uAsUC) < 500 mcg/l, and uCR < 4.5g/L, the remaining 5,400 samples were partitioned, and a calculation method to standardize uAsUC to 1 g/L uCR developed based on uAsUC-stratified power functional regression analysis (PFRA). Findings The obtained standardizing method of variable power-functional creatinine correction (V-PFCRC) represents a progression of reportedly proven simple power-functional modifications of CCRC (S-PFCRC). In contrast to CCRC and S-PFCRC, standardization to 1g/L uCR by V-PFCRC yielded constant uAsN-values over the entire uCR-range in all sextiles. Residual bias was largely neutralized in all sextiles of uAsN (R2 9E-06 - 0.04), compared to uAsUC (R2 0.93 - 0.99) and CCRC (R2 0.42 - 0.89). The efficacy of CRCE compensation was confirmed by simple PFRA in both sexes and seven age bands. The strongest %CRCEs were found in samples at low concentrations of uCR (SBC -0.96) and/or uAsUC (SBC -0.11). Interpretation Standardization to 1g/L uCR by V-PFRA allows for more reliable dilution adjustment of spot urinary results than CCRC and S-PFCRC. As an easily adoptable, novel approach, the calculation method developed in this study can minimize residual dilution bias in urinary biomarkers adjusted by uCR, SG, and osmolality. While minimizing sample rejects, V-PFCRC will improve the reliability and comparability, particularly of lower concentrated urinary biomarkers in both conventional results and multiple linear regression models. Funding Self-funded.

show abstract

An unusual case of severe hypercalcemia: as dehydrated as a bone

Cited by 8 publications

References 12 publications

Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study

Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study

Imaging Pitfalls, When We Should Trust Our Touch

Variable Power Functional Dilution Adjustment of Spot Urine

Contact Info

Product

Resources

About