A new formula for correction of total calcium level into ionized serum calcium values in very elderly hospitalized patients

Pfitzenmeyer, P.; Martin, I.; d’Athis, Philippe; Grumbach, Y.; Delmestre, Marie-Claude; Blonde-Cynober, F.; Derycke, B.; Brondel, Laurent

doi:10.1016/j.archger.2006.10.006

Cited by 24 publications

(17 citation statements)

References 11 publications

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“…Several limitations need to be considered. First, the formula used to estimate calcium adj levels, although serving as the standard formula, is also being criticized for overestimating calcium levels [11,22] and ionized calcium, the physiologically active component, was not directly measured in the current study. Direct measurement is cumbersome and is not performed in routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…In hypoalbuminemia, a common state in stroke patients that predicts poor outcome [9], hypocalcemia is common because of the decrease in the fraction bound to albumin, although the bioactive ionized calcium levels may be in the normal range. In order to neutralize the effect of albumin on calcium level several formulas have been developed [8,10,11]. The aim of the current study was to examine the association between serum total calcium and albumin-adjusted calcium (calcium adj ) levels and long-term outcome in a large cohort of unselected patients with acute stroke.…”

Section: Introductionmentioning

confidence: 99%

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Serum Calcium Levels and Long-Term Mortality in Patients with Acute Stroke

et al. 2010

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Background: Calcium concentrations in serum are maintained within an exquisitely narrow range. Our aim was to examine the association between serum calcium and albumin-adjusted calcium (calcium_adj) levels and stroke outcome in a cohort of unselected patients with acute stroke. Methods: Consecutive patients hospitalized due to acute stroke (ischemic or intracerebral hemorrhage) throughout a large medical center were systematically assessed and followed for 1 year. Baseline total calcium and calcium_adj levels were collapsed into groups of low (<8.6 mg/dl), normal (8.7–9.9 mg/dl) and high (>10 mg/dl) levels and linear and quadratic relations with outcome were examined. Result: Among 784 patients (mean age 70.7 ± 12.5 years, 42.5% females), the mean ± SD total calcium level was 9.3 ± 0.6 mg/dl. For total calcium, the adjusted hazard ratio (HR) for all-cause death over 1 year was 1.83 [95% confidence interval (CI) 1.22–2.75] among patients with low versus normal levels. For calcium_adj, the adjusted HR for all-cause death among women was over 3-fold higher among patients with high calcium_adj levels versus those with normal levels (3.31; 95% CI 1.70–6.46), while no such associations were observed among men. In models developed to estimate the linear and quadratic relations, each unit increment in total calcium squared was associated with an increased adjusted HR of all-cause death over 1 year (p = 0.02) confirming nonlinear associations, and each unit increment in calcium_adj squared was associated with an increased adjusted HR of all-cause death over 1 year among women (p < 0.001) but not among men (p = 0.70). Conclusions: Serum calcium concentrations are a marker of mortality in acute stroke patients, but the associations are not linear, increasing at both extremes of calcium levels. Our findings suggest that long-term survival is optimal in a distinct range of serum calcium levels.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum Calcium Levels and Long-Term Mortality in Patients with Acute Stroke

et al. 2010

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“…Calcium and phosphorus should be measured because tumor invasion may compromise parathyroid function, and unusual ATC cases can present with humoral hypercalcemia of malignancy (91). Since ATC is most common in elderly patients, often with diminished nutrition, ionized calcium provides superior assessment of calcium status (92), although calculations involving serum protein levels and total calcium values may be useful when ionized calcium values are not available (93). Coagulation studies, prothrombin time and activated partial thromboplastin time, should also be obtained.…”

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confidence: 99%

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

Smallridge

Ain

Sylvia

et al. 2012

Thyroid

738

634

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These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.

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“…One for use in very elderly hospitalized patients applies total protein concentration [17]. Another, for use in patients with chronic kidney disease, allows for the increase in phosphate [18].…”

Section: Estimation Of Ionized Calcium From Total Calciummentioning

confidence: 99%

What Is Hypercalcemia? The Importance of Fasting Samples

Siyam

Klachko

2013

Cardiorenal Med

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The differentiation between primary or tertiary (both hypercalcemic) and secondary (normocalcemic) hyperparathyroidism requires the identification of hypercalcemia. Calcium in the blood exists as bound, complexed and ionized fractions. Calcium sensors on parathyroid cells interact only with the ionized fraction (about 50% of the total calcium concentration). Many formulas using albumin, total protein or phosphate to correct or adjust total calcium to reflect the level of ionized calcium may be accurate only within a limited range. In addition, they can introduce errors based on inaccuracies in the measurement of these other metabolites. Clinical conditions, mainly those illnesses affecting acid-base balance, can alter the proportions of bound and free calcium. How and when the blood samples are drawn can alter the level of total calcium. Prolonged standing or prolonged venous stasis causes hemoconcentration, increasing the bound fraction. Preceding exercise can also affect blood calcium levels. Ingestion of calcium supplements or calcium-containing nutrients can cause transient elevations in blood calcium levels lasting several hours, leading to unnecessary further testing. Fasting total calcium levels may be sufficient for monitoring progress. However, for diagnostic purposes, fasting ionized calcium levels should be used. Therefore, for an isolated high total calcium level, we recommend obtaining a repeat fasting total and ionized calcium measurement before further investigations. Hypercalcemia may be diagnosed if there are persistent or frequent total or, preferably, ionized calcium levels >3 SD above the mean of the normal range or if there are progressively rising levels.

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A new formula for correction of total calcium level into ionized serum calcium values in very elderly hospitalized patients

Cited by 24 publications

References 11 publications

Serum Calcium Levels and Long-Term Mortality in Patients with Acute Stroke

Serum Calcium Levels and Long-Term Mortality in Patients with Acute Stroke

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

What Is Hypercalcemia? The Importance of Fasting Samples

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