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Dierkes F, Rakusa J, Scholte JBJ. Fatal Generalized Metastatic Calcifications. JCEM CASE REPORTS 2024; 2:luae168. [PMID: 39346014 PMCID: PMC11427824 DOI: 10.1210/jcemcr/luae168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Indexed: 10/01/2024]
Abstract
Metastatic calcifications are a rare but potentially fatal complication of primary hyperparathyroidism (PHPT). In this case, a 76-year-old man with a previously asymptomatic PHPT developed a hypercalcemic crisis with severe pancreatitis following elective urologic surgery. Despite initial treatment focused on pancreatitis and subsequent organ failure, hypercalcemia persisted, leading to rapid progressive metastatic calcifications in multiple organs. Parathyroidectomy during ongoing pancreatitis successfully reduced calcium levels but not the calcifications. After 4 months of complications and persistent pain, the patient declined further treatment and ultimately succumbed to the disease. The current literature primarily reports single-organ metastatic calcifications due to PHPT. This case represents the only lethal case of systemic metastatic calcifications in the current century. Physicians should be aware of the potential deterioration of hypercalcemia following elective surgery, particularly in the context of renal impairment. Rapid correction of calcium levels may prevent severe complications such as fatal metastatic calcifications.
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Affiliation(s)
- Friederike Dierkes
- Department of Intensive Care Medicine, University Teaching and Research Hospital Lucerne, 6000 Lucerne, Switzerland
| | - Julia Rakusa
- Department of Intensive Care Medicine, University Teaching and Research Hospital Lucerne, 6000 Lucerne, Switzerland
| | - Johannes B J Scholte
- Department of Intensive Care Medicine, University Teaching and Research Hospital Lucerne, 6000 Lucerne, Switzerland
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Ayhan YE, İlerler EE, Sosyal D, Bektay MY, Karakurt S, Daşkaya H, Karaaslan K, Sancar M. Assessment of drug-induced electrolyte disorders in intensive care units: a multicenter observational study. Front Med (Lausanne) 2024; 11:1343483. [PMID: 38895188 PMCID: PMC11184129 DOI: 10.3389/fmed.2024.1343483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Objective Electrolyte disorder (ED) is frequently encountered critically ill patients during admission or admission to the intensive care unit (ICU). This study aimed to determine the frequency of ED encountered in ICU patients to evaluate the relationship of ED with drugs. Methods This prospective, multicenter study was conducted in the medical and anesthesiology ICUs of two training and research hospitals and included patients with at least one ED during admission or hospitalization in the ICUs. The relationship between ED and the drug was evaluated by calculating the logistic probabilistic method scale (LPMS) and the expert panel's evaluation. The correlation between EDs and LPMS was determined using Kendal tau. A binary logistic regression model was preferred in the analysis of factors related to ED. Statistical significance was set as p < 0.05. Results A total of 117 patients were included in the study. A total of 165 EDs were detected, including at least one in 88 (75.2%) patients. According to the expert panel, 61 (21.7%) of EDs were drug-related, whereas according to the LPMS, 111 (39.6%) (p < 0.001). Mortality (50% vs. 13.7%) and mechanical ventilation rates (52.2% vs. 17.2%) were significantly higher in patients with ED (p < 0.001). Patients with ED had 8.352 times higher odds of exhibiting mortality (OR: 8.352, %95 CI: 1.598-43.648, p: 0.012) and need mechanical ventilation with higher odds of 3.229 (OR: 3.229 95% CI: 0.815-12.787 p: 0.045). Patient who required enteral or parenteral feeding were associated with an increased likelihood of exhibiting ED (respectively OR: 30.057, %95 CI: 2.265-398.892, p: 0.01, OR: 5.537, %95 CI: 1.406-21.800, p: 0.014). Conclusion EDs are very common in the ICU. Dysnatremia was detected more commonly in other EDs. It has also been found that patients with ED are more often under mechanical ventilation, have more prolonged hospitalizations, and have higher mortality rates than patients without ED. The suitability of LPMS for assessing ED-drug relationships in the ICU context is questioned.
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Affiliation(s)
- Yunus Emre Ayhan
- Department of Clinical Pharmacy, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Türkiye
| | - Enes Emir İlerler
- Department of Clinical Pharmacy, Marmara University Faculty of Pharmacy, Istanbul, Türkiye
| | - Damla Sosyal
- Department of Clinical Pharmacy, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
| | - Muhammed Yunus Bektay
- Department of Clinical Pharmacy, Faculty of Pharmacy, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Department of Clinical Pharmacy, Bezmialem Vakif University Faculty of Pharmacy, Istanbul, Türkiye
| | - Sait Karakurt
- Department of Chest Diseases and Intensive Care, Faculty of Medicine, Marmara University, Istanbul, Türkiye
| | - Hayrettin Daşkaya
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Kazım Karaaslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Mesut Sancar
- Department of Clinical Pharmacy, Marmara University Faculty of Pharmacy, Istanbul, Türkiye
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Ropero-Luis G, López-Sampalo A, Sanz-Cánovas J, Ruiz-Cantero A, Gómez-Huelgas R. Characteristics of hospitalized patients with hypercalcemia in the province of Malaga: a longitudinal, retrospective, multicenter study. Rev Clin Esp 2023; 223:486-492. [PMID: 37532015 DOI: 10.1016/j.rceng.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVE There are limited studies analyzing hypercalcemia in hospitalized patients. Our objectives were to describe the clinical characteristics of hospitalized patients with hypercalcemia, estimate its prevalence in the hospital setting, analyze the rate of correction of hypercalcemia, and identify prognostic variables. MATERIALS AND METHODS Observational, longitudinal, retrospective, and bicentric study. Adult patients admitted to two hospitals in Málaga (2014-2018) with a diagnosis of hypercalcemia were included. The minimum follow-up was 2 years or until death. RESULTS A total of 205 patients with hypercalcemia were included (incidence: 0.13%). The mean age (SD) was 68.2 (13.1) years, with a predominance of males (55.1%). The median (IQR) serum calcium at admission was 13.1 (11.8-14.6) mg/dl. The most common etiologies were neoplasms (75.1%), primary hyperparathyroidism, and medications (both 8.8%). The median (IQR) follow-up period was 5.1 (1.7-60.3) weeks. The most commonly used treatments were fluid therapy (86.8%), loop diuretics (70.9%), bisphosphonates (60.7%), and glucocorticoids (46.2%). The rate of correction of hypercalcemia was 65.2%, with a median (IQR) of 6 (3-10) days. The mortality rate was 81.5%. The median (95% CI) survival was 5.1 (3-7.3) weeks. Factors associated with higher mortality were advanced age, neoplastic etiology, serum calcium at admission, and failure to correct hypercalcemia. CONCLUSIONS Hypercalcemia in hospitalized patients is mainly due to neoplastic processes and is associated with high mortality. We observed a low rate of adherence to recommendations for the management of hypercalcemia.
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Affiliation(s)
- G Ropero-Luis
- Unidad de Gestión Clínica de Medicina Interna y Especialidades Médicas, Hospital de la Serranía, Ronda, Málaga, Spain; Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - A López-Sampalo
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J Sanz-Cánovas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A Ruiz-Cantero
- Unidad de Gestión Clínica de Medicina Interna y Especialidades Médicas, Hospital de la Serranía, Ronda, Málaga, Spain; Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - R Gómez-Huelgas
- Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA - Plataforma BIONAND), Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Diallo AO, Marcou A, Lespinasse J, Cordoba‐Sosa Z, Andrès E, Docquier L, Lorenzo‐Villalba N. Malignant hypercalcemia revealing a diffuse large B-cell lymphoma in a patient with a previous diagnosis of chronic myelomonocytic leukemia: An uncommon hematological coexistence. Clin Case Rep 2023; 11:e7885. [PMID: 37670819 PMCID: PMC10475757 DOI: 10.1002/ccr3.7885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
A 76-year-old patient previously admitted to the cardiology department for replacement of a right ventricular lead on a double-chamber pacemaker was admitted to the internal medicine department 15 days after for bronchopneumopathy. His past medical history was relevant for Type 2 diabetes mellitus, heart failure due to dilated hypokinetic heart disease, transcatheter aortic valve implantation (TAVI), and chronic myelomonocytic leukemia (CMML-0) diagnosed in 2021. Twenty-four hours after admission, the patient's general condition deteriorated abruptly, with the onset of drowsiness and psychomotor retardation. Laboratory exams revealed hypercalcemia at 4.18 mmol/L. Intensive hydration, calcitonin, and zoledronic acid were initiated and the patient was transferred to the nephrology intensive care unit where he underwent two sessions of hemodialysis to normalize serum calcium levels before readmission to internal medicine. Laboratory exams revealed low parathyroid hormone, normal 1-25-OH vitamin D, and increased parathyroid hormone-related peptide. Thoracoabdominal and positron emission tomography (PET) scan showed diffuse abdominopelvic peritoneal carcinosis associated with low-grade pleural effusion and multiple supra- and sub-diaphragmatic adenopathies, leading to a search for a solid tumor. The patient's clinical condition worsened leading to a transfer to the intensive care unit. The biopsy of a peritoneal carcinosis nodule confirmed the diagnosis of diffuse large B-cell lymphoma. Specific treatments were unsuccessful and the patient expired.
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Affiliation(s)
- Alpha Oumar Diallo
- Service de Médecine InterneHôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Amelie Marcou
- Service de Médecine InterneHôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Jérémie Lespinasse
- Service de Médecine InterneHôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Zaida Cordoba‐Sosa
- Servicio de Medicina InternaHospital General de FuerteventuraPuerto del RosarioSpain
| | - Emmanuel Andrès
- Service de Médecine InterneHôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Léa Docquier
- Service de Médecine InterneHôpitaux Universitaires de StrasbourgStrasbourgFrance
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Aljeaidi MS, Palmer R, Anstey MH. Hypercalcaemia of Immobility in Critically Ill Patients: Case Series. Cureus 2023; 15:e43070. [PMID: 37680410 PMCID: PMC10481884 DOI: 10.7759/cureus.43070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Significant hypercalcaemia can occur in intensive care unit (ICU) patients. Immobilisation hypercalcaemia has been infrequently reported after ICU admission. Patients, therefore, usually require extensive workup to rule out other common causes of hypercalcaemia, such as hyperparathyroidism. A case series of five patients who were diagnosed with hypercalcaemia due to immobilisation and received treatment with pamidronate between 2019 and 2023 were reported. The majority of cases were assessed as having hypercalcaemia due to immobilisation in the setting of low to normal parathyroid hormone levels, no suspicion of malignancy, and absence of other possible causative factors. Treatment with pamidronate started 10 to 60 days after hypercalcaemia was identified, and one or two doses of 30 mg of pamidronate were successful in resolving it. Immobilisation hypercalcaemia following ICU admission was uncommon but treatable with pamidronate.
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Affiliation(s)
- Muhamad S Aljeaidi
- Medical School, The University of Western Australia, Perth, AUS
- Intensive Care Department, Sir Charles Gairdner Hospital, Perth, AUS
| | - Robert Palmer
- Intensive Care Department, Sir Charles Gairdner Hospital, Perth, AUS
| | - Matthew H Anstey
- Medical School, The University of Western Australia, Perth, AUS
- Intensive Care Department, Sir Charles Gairdner Hospital, Perth, AUS
- School of Public Health, Curtin University, Perth, AUS
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Küçük SH, Batur A, Metin Aksu N, Akkaş M. The effect of serum calcium level on the success of diltiazem treatment: A retrospective cohort study. Am J Emerg Med 2023; 71:59-62. [PMID: 37343339 DOI: 10.1016/j.ajem.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Diltiazem is an antiarrhythmic drug widely used in the treatment of atrial fibrillation (AFib) with rapid ventricular response (RVR). It reveals its effect by blocking L-type calcium channels. Thus, it inhibits the extracellular calcium influx into the cytosol. The relationship between serum calcium level and the efficacy of intravenous (IV) diltiazem used in the treatment of AFib with RVR has not been investigated in vivo. The aim of this study is to investigate the mentioned relationship. METHODS This study was planned as a single-center retrospective study. The data of 349 patients who presented to the emergency department with AFib with RVR and treated with diltiazem were retrospectively analyzed. A patient was considered to have responded to diltiazem treatment if the existing heart rhythm returned to sinus rhythm, or the heart rate decreased below 100 beats/min, or the heart rate decreased >20% provided that it was below 120 beats/min. The ionized calcium levels were recorded. The relationship between serum calcium level and the success of diltiazem treatment was examined. RESULTS Fifty five percent of the patients were female. The median age was 75 years. The rate of response to diltiazem treatment was 67.3%. The median of ionized calcium levels in the group which responded to diltiazem treatment (n = 235) was 1.14 mmol/L (IQR: 0.12), and the group which did not respond to diltiazem treatment (n = 114) was 1.11 mmol/L (IQR: 0.12) (p = 0.322). The patients were divided into three groups as low, normal, and high calcium levels according to the calcium reference levels determined by the hospital laboratory. The rate of response to diltiazem treatment was 61.4% in patients with low ionized calcium levels, 76.1% in patients with normal ionized calcium levels, and 40.0% in patients with high ionized calcium levels. The rate of response to diltiazem treatment was higher in patients with normal ionized calcium levels compared to patients with low or high ionized calcium levels (p = 0.004, p = 0.003). CONCLUSION The success rate of diltiazem used in the treatment of AFib with RVR was highest in physiological calcium levels. The current study may provide the clinician with awareness about the consideration of serum ionized calcium levels when choosing drugs in patients with AFib with RVR.
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Affiliation(s)
- Safa Hüseyin Küçük
- Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, 06120 Altindag Ankara, Turkey
| | - Ali Batur
- Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, 06120 Altindag Ankara, Turkey.
| | - Nalan Metin Aksu
- Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, 06120 Altindag Ankara, Turkey
| | - Meltem Akkaş
- Hacettepe University, Faculty of Medicine, Department of Emergency Medicine, 06120 Altindag Ankara, Turkey
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Ravioli S, Lafranchi A, Exadaktylos AK, Haidinger M, Lindner G. Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study. Swiss Med Wkly 2023; 153:40069. [PMID: 37191138 DOI: 10.57187/smw.2023.40069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
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.
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Affiliation(s)
- Svenja Ravioli
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anne Lafranchi
- Department of Nephrology, Bürgerspital Solothurn, Switzerland
| | | | - Michael Haidinger
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Switzerland
| | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland
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Xia X, Cao J, Long C, Chen X, Zheng J. Clinical characteristics of hypercalcemic crises in a tertiary children's hospital. Endocrine 2023:10.1007/s12020-023-03347-1. [PMID: 36897499 DOI: 10.1007/s12020-023-03347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Hypercalcemic crisis is considered a critical and fatal endocrine condition. To date, few reports have focused on hypercalcemic crises in children. AIM To explore the etiology and identify the clinical characteristics related to hypercalcemic crises in children. METHODS We enrolled 101 children diagnosed with hypercalcemia between January 1, 2016 and December 31, 2021, admitted to the Children's Hospital of Chongqing Medical University. Electronic medical records were reviewed to determine the causes and clinical characteristics of hypercalcemic crises. RESULTS Hypercalcemic crises occurred in 28 admissions during the 6-year period; 64% of the patients enrolled in the study were infants. The mean corrected total serum calcium was 4.6 ± 0.2 mmol/l. Tumor and hereditary diseases were found in 12 (43%) and 7 (25%) patients, respectively. The ratio of iatrogenic factors was 11% (3/28), and all 3 patients received a blood transfusion. The incidence of poor prognosis in the tumor cases was 50%. Timely intervention including hemodialysis, pamidronate, and etiological treatment was effective in decreasing calcium levels. CONCLUSION Hypercalcemic crisis is a serious electrolyte disturbance that has the potential for high mortality. The main causes are tumors and hereditary diseases in children. The lack of unique characteristics makes it difficult to recognize by medical caregivers. Early diagnosis and timely intervention could improve the prognosis.
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Affiliation(s)
- Xuhua Xia
- Department of Medical General Ward, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Jie Cao
- Department of Medical General Ward, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Chunli Long
- Department of Medical General Ward, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Xin Chen
- Department of Medical General Ward, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Jiajia Zheng
- Department of Medical General Ward, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Majety P, Groysman A, Erlikh N, Chen ZZ, Westcott GP. Predictors of mortality in hypercalcemia of advanced chronic liver disease. Endocr Pract 2022; 28:1062-1068. [PMID: 35868607 DOI: 10.1016/j.eprac.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hypercalcemia is sometimes observed in patients with cirrhosis, but very little is known about the epidemiology of patients with hypercalcemia of chronic liver disease (HCLD) or how its presence may modulate overall mortality risk. We assessed for associations between clinical and laboratory characteristics of HCLD patients with 90-day mortality. METHODS A systematic search of the medical record at our institution over a 10-year period was performed to retrospectively identify subjects with HCLD during inpatient admission. Univariate and multivariate regression was performed to detect risk factors for all-cause 90-day mortality. RESULTS 38 subjects with HCLD were identified using stringent inclusion and exclusion criteria to exclude individuals with other secondary causes of hypercalcemia. 35 subjects had 90-day vital status available, which revealed 40% mortality. MELD-Na score and duration of inpatient hypercalcemia were positively associated with mortality with respective odds ratios of 1.23 (95% CI 1.06-3.23) and 1.24 (95% CI 1.04-1.49) in a univariate model and 1.30 (95% CI 1.04-1.62) and 1.33 (95% CI 1.04-1.71) in a multivariate regression. Admission and peak serum calcium were not associated with mortality. Only 6 subjects received bisphosphonate or calcitonin during their admission, limiting our ability to assess the impact of treatment on outcomes. CONCLUSIONS In patients admitted to the hospital with HCLD, duration of hypercalcemia was positively associated with 90-day mortality, providing a potential interventional target to reduce mortality in this high-risk population. Studies to validate the utility of treating hypercalcemia are required.
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Affiliation(s)
- Priyanka Majety
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anna Groysman
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Natanie Erlikh
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Zsu Zsu Chen
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gregory P Westcott
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Ramachandran V. Hypercalcemia as the Initial Presentation of Acute T-cell Leukemia/Lymphoma. Cureus 2022; 14:e23705. [PMID: 35505762 PMCID: PMC9056156 DOI: 10.7759/cureus.23705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a T-cell malignancy that generally presents with widespread involvement of lymph nodes, peripheral blood, and/or skin. It is an uncommon malignancy linked to the human T-lymphotropic virus 1 (HTLV-1). Herein, we present a case of ATLL that was diagnosed after a patient presented to our hospital with nonspecific symptoms of fatigue and weakness and was subsequently found to have hypercalcemia secondary to his blood malignancy. We engage in a discussion of the etiology, epidemiology, and management of patients with this rare malignancy as well as the mechanisms that result in hypercalcemia.
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Barth K, Sedivy M, Lindner G, Schwarz C. Successful treatment with denosumab for two cases with hypercalcemia due to vitamin D intoxication and associated acute kidney injury. CEN Case Rep 2022; 11:141-145. [PMID: 34515963 PMCID: PMC8810995 DOI: 10.1007/s13730-021-00643-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
Hypervitaminosis D is a rare reason for hypercalcemia and associated with acute kidney injury. We report on two cases of hypercalcemia and acute kidney injury because of vitamin D intoxication successfully treated with denosumab. Case 1 is an 83-year-old woman, who was initially treated for 2 weeks with intravenous hydration, steroids and thereafter with furosemide without any effect on serum calcium levels and renal function. Because acute renal failure discouraged us to use intravenous bisphosphonate therapy, we applicated 60 mg denusomab subcutaneously. This led to a prompt reduction in serum calcium levels and improvement of renal function within 1 week. Case 2 is a 45-year-old athletic woman, who refused the standard therapy of steroids and forced diuresis for vitamin D intoxication. After 1 day of rehydration therapy, she received 60 mg denusomab. Similar to case 1 serum calcium declined and renal function improved within 7 days.
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Affiliation(s)
- Katharina Barth
- Department of Internal Medicine 2, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Michal Sedivy
- Department of Internal Medicine 1, Pyhrn-Eisenwurzen Klinikum Steyr, Sierningerstraße 170, 4400, Steyr, Austria
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine 1, Pyhrn-Eisenwurzen Klinikum Steyr, Sierningerstraße 170, 4400, Steyr, Austria.
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Mesland JB, Collienne C, Laterre PF, Hantson P. Immobilization-Related Hypercalcemia in a COVID-19 Patient With Prolonged Intensive Care Unit Stay. Am J Phys Med Rehabil 2022; 101:61-63. [PMID: 34657087 PMCID: PMC8667683 DOI: 10.1097/phm.0000000000001907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Immobilization-related hypercalcemia is an uncommon finding in patients admitted to intensive care unit. We report a case of severe hypercalcemia in a COVID-19 patient admitted to intensive care unit for hypoxemic respiratory failure. He developed an acute kidney injury requiring continuous renal replacement therapy with regional citrate anticoagulation. Citrate chelates ionized calcium and stop the coagulation cascade locally, preventing filter clotting. Calcium is then given intravenously to a specific target (normocalcemia). It is only when calcium infusion has been stopped that bone resorption and hypercalcemia were unmasked.
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Bhat NA, Mustafa F, Sheikh RY, Wani I. Incidence, etiology, and course of hypercalcemia-induced AKI in a tertiary care center from northern India. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00067-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hypercalcemia is known to cause acute kidney injury (AKI). Literature related to hypercalcemic AKI is predominantly in the form of case reports and case series. The purpose of this study is to find the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. To our knowledge, this is the first study done to look for the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. This is a prospective observational study conducted in the Department of Medicine in a tertiary care center from Jammu and Kashmir, India, from June 2010 to June 2012. Patients admitted with hypercalcemia were assessed for AKI and evaluated and treated for hypercalcemia. Renal function was monitored during hospitalization and at 1 month of discharge. AKI and hypercalcemia were arbitrarily defined as serum creatinine > 1.5 mg/dl and corrected serum calcium of ≥ 11.5 mg/dl (as per reference hospital lab), respectively.
Results
Thirty patients are included. Hyperparathyroidism and multiple myeloma accounted for 13(43.3%) and 10 (33.3%) cases, respectively. Mean ±SD corrected serum calcium at diagnosis and after treatment at 1 month was 13.56 ± 1.86 mg/dl and 9.49±1.35 mg/dl, respectively; p < 0.001. Mean ±SD serum creatinine at baseline and after treatment of hypercalcemia was 2.87 ±1.68 mg/dl and 1.49±1.34 mg/dl, respectively; p < 0.001. Twenty-three (76.7%) patients had AKI. AKI recovered after treating hypercalcemia in 25 (83.3 %) patients. Mean ± SD days taken for the decrease in serum creatinine to ≤ 1.5 mg/dl was 8.28 ± 4.17 days. Mean ± SD serum creatinine after treatment of hypercalcemia in hyperparathyroidism group versus non-parathyroid group was 0.97 ± 0.35 mg/dl and 1.88 ±1.67 mg/dl, respectively; p value 0.009.
Conclusions
Hypercalcemia is commonly associated with AKI. Primary hyperparathyroidism and multiple myeloma account for the majority of the cases. Hypercalcemic AKI with primary hyperparathyroidism is less common and the outcome is better, as compared to non-hyperparathyroidism-related causes. AKI is reversible in most cases.
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Bentata Y, Benabdelhak M, Haddiya I, Oulali N, Housni B. Severe hypercalcemia requiring acute hemodialysis: A retrospective cohort study with increased incidence during the Covid-19 pandemic. Am J Emerg Med 2021; 51:374-377. [PMID: 34823193 PMCID: PMC8585552 DOI: 10.1016/j.ajem.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background The Covid-19 pandemic has had dramatic consequences on the progression of numerous pathologies, especially neoplastic ones. The orientation of hospital activities toward the care of patients with SARS-Cov2 infection has caused significant delays in the diagnosis and therapy of many other pathologies. What about severe hypercalcemia? The aim of this work was to determine the clinical and biological presentation, etiologies, mortality, and the impact of the Covid-19 pandemic on severe hypercalcemia. Material and methods we conducted a retrospective study for 84 months (September 2014 to September 2021) at the Nephrology Unit in University Hospital Mohammed VI, Oujda, Morocco. Included were all adult patients diagnosed with severe hypercalcemia (defined as corrected total serum calcium of >3.5 mmol/l or > 14.0 mg/dl) and who had benefited from one or more hemodialysis sessions. Results 66 episodes of severe hypercalcemia occurred in 64 patients. The mean age was 57 ± 15 years and 57.6% were female. The mean corrected serum calcium at admission was 16.9 ± 2.1 mg/dl and 33.3% had more than 18.0 mg/dl. Malignancies represented 80.4% of all etiologies. Acute kidney injury was observed in 69.7%. The delta drop in serum calcium 48 h after initiation of medical treatment was 4.64 ± 1.63 mg /dl. Mortality was noted in 14% of all cases. Electrocardiographic abnormalities were observed in 58.3%, 87.5% and 85.7%, respectively, in group 1 (14.0–16.0 mg/dl), group 2 (16.1–18.0 mg/dl), and group 3 (> 18.0 mg/dl) (p = 0.04). The mean serum potassium value was 5.1 ± 1.3, 4.0 ± 1.0, and 3.7 ± 0.7 respectively, in group 1 (14.0–16.0 mg/dl), group 2 (16.1–18.0 mg/dl), and group 3 (> 18.0 mg/dl) (p < 0.001). Newly diagnosed neoplasia, severe hypercalcemia (> 16.0 mg/dl), and mortality have been observed in 15.4% vs. 23.7% (p = 0.31), 25% vs. 50% (p = 0.03), and 35.7% vs. 52.6% (p = 0.13) respectively, in patients before and during the Covid-19 pandemic. Conclusions The Covid-19 pandemic caused an increase in both the incidence and severity of hypercalcemia and the hemodialysis practiced in this context remains efficient and safe.
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Affiliation(s)
- Y Bentata
- Nephrology - Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research, and Public Health, Medical School, University Mohammed First, Oujda, Morocco.
| | - M Benabdelhak
- Nephrology - Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
| | - I Haddiya
- Nephrology - Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research, and Public Health, Medical School, University Mohammed First, Oujda, Morocco
| | - N Oulali
- Emergency Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
| | - B Housni
- Intensive Care Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
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Rosenblum RC, Twito O, Barzilay-Yoseph L, Ramaty E, Klein N, Rotman-Pikielny P. Efficacy and Safety of Intravenous Pamidronate for Parathyroid Hormone-dependent Hypercalcemia in Hospitalized Patients. J Clin Endocrinol Metab 2021; 106:e4593-e4602. [PMID: 34157125 DOI: 10.1210/clinem/dgab457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Bisphosphonates are effective for hypercalcemia of malignancy (HOM). Efficacy and safety data for bisphosphonates in parathyroid hormone-related hypercalcemia (PTHRH) are rare, including pamidronate (Pam), which is not indicated for this condition. OBJECTIVE This work aims to evaluate the efficacy and safety of Pam for moderate-to-severe PTHRH. METHODS This retrospective case-control study was conducted at a tertiary care medical center. Patients included adults hospitalized with serum calcium levels greater than 12 mg/dL, from October 29, 2013 to December 17, 2019. Etiology was categorized as PTHRH or PTH-independent. Clinical and laboratory data of PTHRH patients treated with Pam (PTHRH-Pam+) were compared to Pam-untreated counterparts (PTHRH-Pam-). RESULTS Thirty-four patients with 37 hospitalizations for PTHRH (Pam-treated and -untreated) met the inclusion criteria. Pam was given in 24 of 37 cases (64.8%). Admission serum calcium levels for the PTHRH-Pam+ group were higher than for PTHRH-Pam- group (14.4 mg/dL vs 13.0 mg/dL, P = .005). Median total Pam dose was 60 mg (range, 30-180 mg) in the treated group. Serum calcium decreased 3.5 mg/dL for PTHRH-Pam+ vs 1.6 mg/dL for PTHRH-Pam- (P = .003). No PTHRH-Pam+ patients developed hypocalcemia or acute kidney injury. Nadir serum phosphorus levels were lower in the PTHRH-Pam+ vs PTHRH-Pam- group (1.7 mg/dL vs 2.4 mg/dL, respectively, P = .004). Three PTHRH-Pam+ patients developed severe hypophosphatemia; all resolved with intravenous and oral supplementation. Seventeen patients underwent parathyroidectomy, of whom 10 received Pam within 28 days preoperatively. Postoperatively, 4 developed hypocalcemia and 3 hypophosphatemia. CONCLUSION This study demonstrates that Pam is effective and safe for treating PTHRH, while ensuring close laboratory monitoring of calcium and phosphorus metabolism. Larger, prospective studies are needed to establish the role of Pam and other potent bisphosphonates in moderate-to-severe PTHRH.
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Affiliation(s)
| | - Orit Twito
- Endocrine Institute, Meir Medical Center, Kfar Saba 44281, Israel
| | | | - Erez Ramaty
- Endocrine Institute, Meir Medical Center, Kfar Saba 44281, Israel
| | - Noa Klein
- Endocrine Institute, Meir Medical Center, Kfar Saba 44281, Israel
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Banu S, Batool S, Sattar S, Masood MQ. Malignant and Non-Malignant Causes of Hypercalcemia: A Retrospective Study at a Tertiary Care Hospital in Pakistan. Cureus 2021; 13:e15845. [PMID: 34322336 PMCID: PMC8298208 DOI: 10.7759/cureus.15845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Hypercalcemia is a common electrolyte abnormality presenting with a variety of symptoms. The common causes are primary hyperparathyroidism and malignancy associated with hypercalcemia. However, iatrogenic hypercalcemia with the overzealous use of vitamin D has now emerged as another important cause of hypercalcemia over the past decade. Objective: This study aims to evaluate the causes of hypercalcemia, management strategies, and outcomes in patients admitted with hypercalcemia in a tertiary care hospital. Method: It is a retrospective study done at Aga Khan University Hospital (AKUH), Karachi after taking approval from the ethical review committee (ERC). Data were gathered about all patients admitted from 1st January 2008 to 31st December 2018. A total of 1142 patients were included in the study and their calcium levels were noted. Along with demographic details, data pertaining to their diagnosis and all investigations done to evaluate the causes of hypercalcemia were noted in a pre-defined questionnaire. Results: A total of 814 patients having hypercalcemia were included in the final analysis and their mean age was 60.8 ± 14.1 years. Male and female patients were 45.4% and 54.6%, respectively, and their mean hospital stay was 6.2 ± 5.8 days. The most common cause of hypercalcemia was malignant solid tumors (49.1%), followed by hematological malignancy (16.5%), hyperparathyroidism (10.9%), definite vitamin D toxicity (8%), chronic kidney disease (4.9%), chronic granulomatous diseases (4.7%), and probable vitamin D toxicity (3.5%). The oral cavity carcinoma (17.7%) was the most common solid tumor associated with hypercalcemia. Amongst hematological malignancy, multiple myeloma (14.4%) was the most common one. Out of 814 patients admitted with hypercalcemia, 601 (74%) patients recovered from hypercalcemia, while mortality was observed in 129 (16%) patients. Of those who expired, 110 (85.3%) had malignancy either solid tumor or hematological. Conclusion: Malignancy is the most common cause of hypercalcemia in admitted patients. The knowledge of hypercalcemia’s causes is of great importance so that targeted investigations can be done. Not only will it minimize the cost burden and shorten the hospitalization of patients; it will also help the physicians to decide the appropriate management accordingly. Moreover, vitamin D toxicity was also observed in a significant number of patients which highlights the common practice of using higher doses of vitamin D by physicians.
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Affiliation(s)
- Sabiha Banu
- Endocrinology and Diabetes, Aga Khan University Hospital, Karachi, PAK
| | - Sumera Batool
- Endocrinology and Diabetes, Aga Khan University Hospital, Karachi, PAK
| | - Saadia Sattar
- Medicine, Aga Khan University Hospital, Karachi, PAK
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Reintam Blaser A, van Zanten ARH. Electrolyte disorders during the initiation of nutrition therapy in the ICU. Curr Opin Clin Nutr Metab Care 2021; 24:151-158. [PMID: 33394599 DOI: 10.1097/mco.0000000000000730] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW To summarize recent evidence on prevalence, risk factors, significance, treatment, and prevention of electrolyte disorders in critically ill with a specific focus on disorders during the initiation of nutrition. RECENT FINDINGS Electrolyte disturbances appear to occur often during critical illness, and most of them seem to be associated with impaired outcome. However, a recent systematic review indicated insufficient evidence to answer clinically relevant questions regarding hypophosphatemia. Similar questions (which thresholds of serum levels are clinically relevant; how serum levels should be corrected and how do different correction regimens/approaches influence outcome) are not clearly answered also for other electrolytes. The most crucial feature of electrolyte disturbances related to feeding is refeeding syndrome. Recent evidence supports that additionally to the correction of electrolyte levels, a temporary restriction of calories (reducing the magnitude of this metabolic feature, including electrolyte shifts) may help to improve outcome. SUMMARY Diverse electrolyte disorders often occur in critically ill patients. Hypophosphatemia, hypokalemia, and hypomagnesemia that are encountered after initiation of feeding identify refeeding syndrome. Along with correction of electrolytes, reduction of caloric intake may improve the outcome of the refeeding syndrome.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Arthur Raymond Hubert van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Dalemo S, Boström KB, Hjerpe P. Plasma albumin and calcium concentrations, and long-term mortality in primary health care patients in Sweden. Scand J Prim Health Care 2020; 38:430-438. [PMID: 33226880 PMCID: PMC7783069 DOI: 10.1080/02813432.2020.1843809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Low plasma (p)-albumin and p-calcium concentrations are associated with increased mortality in hospitalised patients. There are few studies addressing this in primary care. Low p-calcium has been associated with mortality, but it is not known whether this applies to p-albumin. Could p-albumin and p-calcium be used as markers of an increased risk of mortality? PURPOSE To study p-albumin and p-calcium at baseline and their association with mortality after 10-14 years. DESIGN Prospective cohort study using data from a large primary health care area and the National Swedish Cause of Death Register. SETTING Primary health care in Skaraborg, Sweden. SUBJECTS 43,052 patients (39.1% men), ≥18 years, 60.7 ± 18.4 years with p-albumin and p-calcium concentrations registered in 2001-2005. MAIN OUTCOME MEASURES P-albumin and p-calcium concentrations at baseline and their association with mortality after a mean follow-up period of 10.3 ± 4.0 years. RESULTS Low p-albumin was associated with total mortality compared with normal p-albumin, greatest at lower ages (18-47 years). The hazard ratios for women and men were 3.12 (95% CI 1.27-7.70) and 4.09 (95% CI 1.50-11.14), respectively. The increased mortality was seen in both cardiovascular and malignant diseases in both women and men. In contrast, low p-calcium was not associated with increased mortality, 1.00 (95% CI 0.96-1.05). Elevated p-calcium was associated with increased mortality, 1.17 (95% CI 1.13-1.22). CONCLUSIONS Low p-albumin could be a marker of an increased risk of mortality, especially in patients of younger ages. This finding should prompt diagnostic measures in order to identify underlying causes. KEY POINTS Low p-albumin and calcium concentrations have been associated with increased mortality in hospitalised patients, but this is unexplored in primary care patients. A low p-albumin concentration at baseline was a risk marker for mortality; highest in the younger age groups. Increased mortality in both cardiovascular and malignant diseases was seen in both men and women with low compared with normal p-albumin concentrations. Elevated but not low p-calcium concentrations were associated with increased mortality after 10-14 years of follow-up.
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Affiliation(s)
- Sofia Dalemo
- Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
- CONTACT Sofia Dalemo Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Bengtsson Boström
- Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Per Hjerpe
- Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
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Martucci G, Bonicolini E, Parekh D, Thein OS, Scherkl M, Amrein K. Metabolic and Endocrine Challenges. Semin Respir Crit Care Med 2020; 42:78-97. [PMID: 32882734 DOI: 10.1055/s-0040-1713084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.
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Affiliation(s)
- Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
| | - Eleonora Bonicolini
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
| | - Dhruv Parekh
- Critical Care, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Onn Shaun Thein
- Critical Care, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mario Scherkl
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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