Calcium Disorders in the Emergency Department: Independent Risk Factors for Mortality

Sauter, Thomas C.; Lindner, Gregor; Ahmad, Sufian S.; Leichtle, Alexander Benedikt; Fiedler, Georg Martin; Exadaktylos, Aristomenis K.; Haider, Dominik G.

doi:10.1371/journal.pone.0132788

Cited by 27 publications

(16 citation statements)

References 24 publications

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“…One national report in the UK stated that in-hospital AKI could have been avoided in one-fifth of the patients if they had received better monitoring of electrolytes, recognition of risk factors, and prompt management [37]. In our study, EAD was associated with a 2.0-fold increase in the hazard ratio of in-hospital death, as well as longer length of stay and higher hospital costs, consistent with other studies [38][39][40]. The median survival time sustained declining along with the rise of EAD number and severity.…”

Section: Discussionsupporting

confidence: 89%

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

et al. 2020

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Background: This study aims to delineate the incidence of electrolyte and acid-base disorders (EAD) in cancer patients, to figure out the risk factors of EAD, then to assess the impact of EAD on patients' in-hospital clinical outcomes. Methods: Patients with the diagnosis of malignancies hospitalized during 1 October 2014 and 30 September 2015 were recruited in Zhongshan Hospital, Fudan University in Shanghai of China. Demographic characteristics, comorbidities, and clinical data, including survival, length of stay and hospital cost, were extracted from the electronic medical record system. Electrolyte and acid-base data were acquired from the hospital laboratory database. Results: Of 25,881 cancer patients with electrolyte data, 15,000 (58.0%) cases had at least one electrolyte and acid-base abnormity. Hypocalcemia (27.8%) was the most common electrolyte disorder, followed by hypophosphatemia (26.7%), hypochloremia (24.5%) and hyponatremia (22.5%). The incidence of simple metabolic acidosis (MAC) and metabolic alkalosis (MAL) was 12.8% and 22.1% respectively. Patients with mixed metabolic acid-base disorders (MAC þ MAL) accounted for 30.2%. Lower BMI score, preexisting hypertension and diabetes, renal dysfunction, receiving surgery/chemotherapy, anemia and hypoalbuminemia were screened out as the major risk factors of EAD. In-hospital mortality in patients with EAD was 2.1% as compared to those with normal electrolytes (0.3%). The risk of death significantly increased among patients with severe EAD. Similarly, the length of stay and hospital cost also tripled as the number and grade of EAD increased. Conclusion: EAD is commonly encountered in cancer patients and associated with an ominous prognosis. Patients with comorbidities, renal/liver dysfunction, and anti-tumor therapy have a higher risk of EAD. Regular monitoring of electrolytes, optimum regimen for intravenous infusion, timely correction of modifiable factors and appropriate management of EAD should not be neglected during anti-tumor treatment.

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Section: Discussionsupporting

confidence: 89%

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

et al. 2020

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“…Therefore, it seems obvious that hypocalcemia will affect cardiac contractility, and this was proved in current studies (3). Meanwhile, recent evidence suggests that vitamin D and parathormone (PTH) may have an independent role to play, also (4,5).…”

Section: Introductionmentioning

confidence: 62%

Hypocalcemic Cardiomyopathy - a Rare Heart Failure Etiology in Adult

et al. 2019

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Introduction. Heart failure and dilated cardiomyopathy (DCM) in adults are rarely caused by hypoparathyroidism induced hypocalcemia. Case report. Female patient, 40 years old, diabetic, with previous history of thyroidectomy for Graves' disease, was hospitalized for syncope and symptoms of heart failure. ECG revealed sinus tachycardia, long QT, negative T from V1 up to V4. Chest X-ray, cardiac ultrasound and contrast cardiac MRI confirmed dilated left chambers, severe systolic dysfunction of the left ventricle (left ventricle ejection fraction=15%) due to diffuse hypokinesia and restrictive type of diastolic dysfunction. Patient status insignificantly improved with specific heart failure depletion treatment but important signs of hypocalcemia occurred. Low levels of total and ionic serum calcium were detected (total serum calcium 3.6 mg/dL, ionic calcium=2.2 mg/dL) along with low serum levels of parathormone (10 pg/mL) and high level of phosphatemia (6.4 mg/dL). After one month of parenteral treatment with calcium and oral vitamin D, hypocalcemic signs disappeared and heart failure significantly improved. Conclusion. This rare adult condition is refractory to heart failure conventional therapy but promptly responds to restoration of normocalcemia. It is important to be aware of this pathophysiological setting, in order to treat it correctly.

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“…Reports have found conflicting results with either no association of calcium levels with mortality or both high and low levels of Ca reported to be associated with an increase in mortality ( 1 , 2 , 3 , 4 , 29 ). Sauter et al studied unselected patients admitted to the ED and found that both hypocalcemia and hypercalcemia were associated with increased 28-day in-hospital mortality ( 1 ). Egi et al found similar results in patients admitted to ICU ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…There has been growing interest in hypocalcemia as an independent risk factor for mortality among patients admitted to the emergency department (ED) and ICUs ( 1 , 2 , 3 , 4 ). Recently, hypocalcemia has been associated with the risk of sudden cardiac arrest (SCA) in the community ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Is severe hypocalcemia immediately life threatening?

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Bach-Ngohou

Masson

et al. 2018

Endocrine Connections

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ObjectiveSevere hypocalcemia (Ca <1.9 mmol/L) is often considered an emergency because of a potential risk of cardiac arrest or seizures. However, there is little evidence to support this. The aim of our study was to assess whether severe hypocalcemia was associated with immediately life-threatening cardiac arrhythmias or neurological complications.MethodsA retrospective observational study was carried out over a 2-year period in the Adult Emergency Department (ED) of Nantes University Hospital. All patients who had a protein-corrected calcium concentration measure were eligible for inclusion. Patients with multiple myeloma were excluded. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED.ResultsA total of 41,823 patients had protein-corrected calcium (pcCa) concentrations measured, 155 had severe hypocalcemia, 22 were excluded because of myeloma leaving 133 for analysis. Median pcCa concentration was 1.73 mmol/L (1.57–1.84). Seventeen (12.8%) patients presented a life-threatening condition, 14 (10.5%) neurological and 3 (2.2%) cardiac during ED stay. However, these complications could be explained by the presence of underlying co-morbidities and or electrolyte disturbances other than hypocalcemia. Overall, 24 (18%) patients died in hospital. Vitamin D deficiency, chronic kidney disease and hypoparathyroidism were the most frequently found causes of hypocalcemia.ConclusionThirteen percent of patients with severe hypocalcemia presented a life-threatening cardiac or neurological complication on the ED. However, a perfectly valid alternative cause could account for these complications. Further research is warranted to define the precise role of hypocalcemia.

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Calcium Disorders in the Emergency Department: Independent Risk Factors for Mortality

Cited by 27 publications

References 24 publications

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China

Hypocalcemic Cardiomyopathy - a Rare Heart Failure Etiology in Adult

Is severe hypocalcemia immediately life threatening?

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