Is severe hypocalcemia immediately life threatening?

Abstract

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.

Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

“…Additionally, hypocalcemia itself has been linked to certain complications. Severe hypocalcemia has been linked to life-threatening cardiac arrhythmia and seizures [ 10 ]. Low calcium levels have been specifically discussed in relation to several neurological and cardiac complications, including seizures, status epilepticus, and coma among other complications, although there is discussion as to whether or not these complications may be explained by other causes unrelated to calcium [ 10 ].…”

Severe hypocalcaemia in a COVID-19 female patient

“…Severe patients are at risk of hypocalcaemia due to the effect of inflammatory mediators such was in this case. Duval et al state that severe hypocalcaemia, defined by a serum calcium level <1.9 mmol/L or <7.6 mg/dL, is often considered an emergency because of cardiac arrhythmias or seizure ( 3 ). Our patient had bradycardia and extrasystoles and the serum corrected calcium level was 5.7 mg/dL.…”

“…One of them may be hypocalcaemia, which is common in critically ill patients. Many factors influence serum calcium concentration such as parathyroid hormone (PTH), vitamin D level, calcitonin, hypoalbuminemia, and electrolyte disturbances ( 3 , 4 , 5 ). In this report, we present a case of an 81-year-old female confirmed with COVID-19 infection who developed asymptomatic hypocalcaemia with severe hypocalcaemia and vitamin D deficiency.…”

Rapidly Developing Cataract in Young Adult Patients: Always a Matter for Further Evaluation

“…Hypocalcemia is characterized by muscle cramps, tetany, fatigue, paraesthesia, headache, and abdominal pain. Seizures and cardiac arrhythmias are life-threatening emergencies associated with hypocalcemia [ 2 ].…”