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

Abstract

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.

The association between albumin-corrected calcium and prognosis in patients with cardiac arrest: a retrospective study based on the MIMIC-IV database

“…Although abnormal serum calcium concentrations are not factored into the acute physiology and chronic health evaluation prediction system for assessing prognosis in ICU patients, they are highly prevalent in this population. Disruptions in calcium metabolism have the potential to influence the excitability of the neuromuscular system, resulting in arrhythmias, multi-organ dysfunction, and in severe cases, coma, and CA [ 13 ]. The relationship between different serum calcium levels and mortality of various diseases was explored by previous studies.…”

Malignant hypercalcemia revealing a diffuse large B‐cell lymphoma in a patient with a previous diagnosis of chronic myelomonocytic leukemia: An uncommon hematological coexistence

“…Hypercalcemia could result from osteolytic lesions or from production of humoral substances like parathyroid hormone‐related protein (PTHrP) or uncontrolled synthesis and secretion of 1‐25(OH) 2 D3 by the tumoral cell or macrophages. Within tumor‐related etiologies, multiple myeloma, breast, lung, and kidney cancers are the most frequent 3,4 . In these diseases, hypercalcemia has been reported in 30% and 60% of patients with multiple myeloma and T‐cell non‐Hodgkin lymphoma (NHL) 1 .…”

“…Within tumor‐related etiologies, multiple myeloma, breast, lung, and kidney cancers are the most frequent. 3 , 4 In these diseases, hypercalcemia has been reported in 30% and 60% of patients with multiple myeloma and T‐cell non‐Hodgkin lymphoma (NHL). 1 However, hypercalcemia has only been reported in 7%–8% of patients with B‐cell NHL and its prevalence and its prognostic value is unclear.…”

Malignant hypercalcemia revealing a Diffuse large B cell lymphoma in a patient with a previous diagnosis of chronic myelomonocytic leukemia: an uncommon hematological coexistence

“…Hypercalcemia could result from osteolytic lesions or from production of humoral substances like parathyroid hormone-related protein (PTHrP) or uncontrolled synthesis and secretion of 1-25(OH) 2 D3 by the tumoral cell or macrophages. Within tumor-related etiologies, multiple myeloma, breast, lung, and kidney cancers are the most frequent [3,4]. In these diseases, hypercalcemia has been reported in 30% and 60% of patients with multiple myeloma and T-cell non-Hodgkin lymphoma [1].However, hypercalcemia has only been reported in 7-8% of patients with B-cell non-Hodgkin lymphoma (NHL) and its prevalence and its prognostic value is unclear [2].…”