Determinants of hypercalcemia and hypercalciuria in immobilized trauma patients

Abstract

Hypercalcemia and hypercalciuria secondary to immobilization can be occasionally severe, producing an array of symptoms. This study looked at possible determinants of hypercalcemia and hypercalciuria in immobilized trauma patients. This is a prospective observational study carried out over a period of 7 months. Fifty-five immobilized trauma patients were evaluated weekly for 4 weeks for symptoms of hypercalcemia, total serum calcium and 24-h urinary calcium. The number of limbs immobilized had a significant relationship with hypercalcemia at the end of week 1 (Po0.001) and week 4 (P ¼ 0.008) and with hypercalciuria at the end of week 1 only (Po0.001). The number of bones fractured also had a significant relationship with hypercalcemia at the end of week 1 (P ¼ 0.005) and week 4 (P ¼ 0.019), as well as with hypercalciuria at the end of week 1 (Po0.001) and week 2 (P ¼ 0.036). Weight loss was significantly associated with hypercalcemia at the end of week 4 (P ¼ 0.014) and with hypercalciuria at the end of week 3 (Po0.001) and week 4 (Po0.001), whereas polyuria and polydipsia had a significant association with hypercalciuria at the end of week 2 (Po0.001) and week 3 (P ¼ 0.030). The number of limbs immobilized and bones fractured showed an early significant relationship with the development of hypercalcemia and hypercalciuria. Weight loss showed late association with hypercalcemia and hypercalciuria, whereas polyuria and polydipsia showed early association with hypercalciuria.

Hypocalcemia in trauma patients: A systematic review

“…It is also worth considering that a small subset of the critically ill trauma patient population might in fact suffer the often initially asymptomatic adverse effects of hypercalcemia including seizures and respiratory arrest, 49 , 50 although this has only been noted in patients who have been immobilized for several weeks and not lost significant quantities of blood. In such a patient population, prehospital correction of presumed hypocalcemia may be superfluous or potentially even dangerous.…”

Immobilization-induced symptomatic hypercalcemia treated with zoledronate in a child with a left ventricular assist device

“…The diagnosis of hypercalcemia is often made incidentally when a high level of calcium is detected in the blood (3). The classic definition of hypercalcemia due to immobilization of a patient without the pre-existing metabolic bone disease was made by Albright et al (10).…”

“…It occurs when osteoclastic bone resorption exceeds the rate of osteoblastic bone formation, causing an imbalance in the bone remodeling process [ 2 ]. Such hypercalcemia is either asymptomatic or has vague clinical features [ 3 ]. However, it is occasionally severe and can cause various symptoms, such as neuromuscular findings, seizures, and respiratory arrest [ 3 ].…”

“…Such hypercalcemia is either asymptomatic or has vague clinical features [ 3 ]. However, it is occasionally severe and can cause various symptoms, such as neuromuscular findings, seizures, and respiratory arrest [ 3 ]. Albright was the first to describe immobilization-induced hypercalcemia in 1941, in a 14-year-old adolescent [ 4 ].…”

The Effectiveness of Ultrasonography in Detecting Emergent Pediatric Pathologies and Requirement for Additional Imaging Techniques: A Retrospective Study

“…İmmobilizasyona bağlı olarak kemik formasyonu baskılanırken, kemik yıkımında artış sonucu iskelet sisteminde kalsiyum kaybı ile birlikte hiperkalsemi gelişmektedir. 23,26 Uzamış immobilizasyon hiperkalsiüriye yol açmaktadır.…”