Calcium, Magnesium, and Phosphate Abnormalities in the Emergency Department

Chang, Wan‐Tsu W.; Radin, Bethany; McCurdy, Michael T.

doi:10.1016/j.emc.2013.12.006

Cited by 45 publications

(41 citation statements)

References 27 publications

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“…Overall, our findings are consistent with those of other studies. Hypercalcaemia has commonly been reported in malignancy and hyperparathyroidism . Hypocalcaemia is commonly associated with paraesthesias .…”

Section: Discussionmentioning

confidence: 99%

Risk variables associated with abnormal calcium, magnesium and phosphate levels among emergency department patients

Taylor

Date

Ugoni

et al. 2019

Emerg Medicine Australasia

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Objective The utility of calcium, magnesium and phosphate measurement in the ED is limited. We aimed to determine clinical risk variables for abnormal levels of these electrolytes in order to inform the development of an ordering guideline. Methods We performed a retrospective, observational study of patients who presented to a tertiary referral ED between January and June 2017. Adult patients who had serum calcium, magnesium or phosphate tests completed during their ED stay were included. Presenting symptoms and signs, comorbidities, medication use and laboratory values were extracted from the medical record. Patients with missing data items were excluded. Logistic regression models determined clinical risk variables associated with low and high levels of each electrolyte. Results A total of 33 120 adults presented during the study period. Of the 1679 calcium, 1576 magnesium and 1511 phosphate tests, 228 (13.6%), 158 (10.0%) and 387 (25.6%) were abnormal, respectively. Significant risk variables (P < 0.05) for abnormal levels were: hypocalcaemia – vomiting, perioral numbness, hand/foot spasm, calcium and phosphate supplements and chemotherapy (odds ratio [OR] range 5.9–17.3); hypercalcaemia – female sex, vomiting, polyuria, confusion, hyperparathyroidism, cancer and type 1 diabetes (OR range 2.3–9.7); hypomagnesemia – female sex, proton pump inhibitor use, tacrolimus use, alcohol abuse and type 2 diabetes (OR range 2.2–13.1); hypermagnesemia – lethargy, thiazide use and chronic kidney disease (OR range 4.3–4.5); hypophosphatemia – nausea, seizure and glucocorticoid use (OR range 1.7–2.1); and hyperphosphataemia – polyuria, diuretics and chronic kidney disease (OR range 1.9–5.0). Conclusion A range of demographic, comorbid, medication and clinical variables are associated with abnormal calcium, magnesium and phosphate levels. These findings will inform the development of clinical guidelines to rationalise calcium, magnesium and phosphate testing. Justification may be required for testing patients with no risk variables.

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Section: Discussionmentioning

confidence: 99%

Risk variables associated with abnormal calcium, magnesium and phosphate levels among emergency department patients

Taylor

Date

Ugoni

et al. 2019

Emerg Medicine Australasia

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“…Other patients usually remain alert until their serum calcium levels rise greater than 14 mg/dL (Stewart, 2005). Neurologic complications may progress to hallucinations, seizures, and coma in severe hypercalcemia if left untreated (Chang et al, 2014).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…In addition to the symptoms listed in Table 2, many patients with hypercalcemia related to malignancy also develop hypokalemia, which further contributes to the risk of arrhythmias in this population. Although calcium exhibits positive inotropic effects at levels less than 15 mg/dL, severe hypercalcemia may cause myocardial depression and can be grave enough to lead to atrioventricular block, with levels greater than 20 mg/dL leading to cardiac arrest (Chang, Radin, & McCurdy, 2014).…”

Section: Clinical Presentationmentioning

confidence: 99%

Emergency Management of Malignancy-Associated Hypercalcemia

Dellay

Groth

2016

Advanced Emergency Nursing Journal

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The most common cause of hypercalcemia in the emergency department (ED) is malignancy-associated hypercalcemia (MAH), which can be caused by direct bone resorption from bone metastases, vitamin D secreting malignancies, and increased parathyroid hormone (PTH) or PTH-related protein (PTHrP) levels. Malignancy-associated hypercalcemia is associated with a very poor prognosis, with half of the patients dying within a month of diagnosis. Management consists of adequate hydration, bisphosphonate therapy, and correction of other abnormal electrolyte levels. Currently, no therapies have demonstrated an effect on mortality and are therefore viewed only as a means of stabilizing the patient until the underlying condition can be treated. All MAH patients should receive an oncology consult as soon as possible so they are able to receive treatment for the causative malignancy and increase their chance of survival.

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“…Calcium and its compounds play an important role in contracting skeletal and cardiac muscles, intracellular secretion, mediator excitation in synapses, the generation of potentials in some activate structures, maintaining the necessary balance between activation and inhibition in the cerebral cortex, affecting peroxide lipid oxidation, transportation of ions through a cell membrane, activity of various groups of enzymes, humoral and cellular immunity, hemodynamics and microcirculation, aggregate state of blood, glycogenolysis and glucone genesis, hormonal secretion, iodine exchange, growth and bone formation, mineralization of bone tissue, functioning of the hypothalamic-pituitary system, etc. [2,3,5,9,12,14]. About 99% of calcium is found in bone and cartilage tissues in the form of hydroxyapatite crystals (the main depot of Ca in the organism), the rest -in soft tissues and extracellular fluid [1,15,16,17].…”

Section: Problem Statement and Analysis Of The Recent Researchmentioning

confidence: 99%

“…Bone tissue contains 80% of the total amount of phosphorus (in the form of crystals of hydroxyapatite). Adequate concentration of phosphorus in blood is the necessary condition for normal mineralization [2,6,9,11,12,13].…”

Section: Problem Statement and Analysis Of The Recent Researchmentioning

confidence: 99%

Calcium Metabolism Indicators in Patients with Generalized Periodontitis and Hypertension

Vivcharenko

Рожко

2018

Arch. clin. med.

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The objective of the study is to determine the level of calcium in patients with hypertension of the II degree and generalized periodontitis of the II degree. There were examined 30 patients with hypertension of the II degree with generalized periodontitis of the II degree. Patients' age ranged from 35 to 54 years. These patients were in the main group. Treatment of patients included taking the medicine "Ca-D 3 NIKOMED". The control group included 10 patients without general somathic pathology and with healthy periodontitis of the same age. The results obtained were subject to variational and statistical processing. The analyses were carried out before and 3 months after the treatment. The level of general Ca in patients with generalized periodontitis of the II degree and hypertension of the II degree before the treatment was 1.66±0.03 mmol/l (p<0.001) (norm 2.15-2.5 mmol/l). In the patients of control group this figure was 2.33±0.04 mmol/l (p<0.001). After 3 months the level of general Ca in patients with generalized periodontitis of the II degree and hypertension of the II degree was 1.87±0.03 mmol/l (p<0.001). The level of ionized Ca in patients with generalized periodontitis of the II degree and hypertension of the II degree before the treatment was 0.36± 0.01 mmol/l (p<0.001); after the treatment the level of ionized Ca was 0.41±0.01 mmol/l (p<0.001). The level of ionized Ca in control group patients was 1.03±0.02 mmol/l (p<0.001). We can conclude: according to the analysis of levels of general and ionized calcium in serum of patients with generalized periodontitis of the II degree and hypertension of the II degree we can conclude that these indexes are lower than normal; patients with generalized periodontitis of the II degree and hypertension of the II degree have increased levels of general calcium and ionized calcium in serum after taking the drug "Ca-D 3 NIKOMED"during 3 months.

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Calcium, Magnesium, and Phosphate Abnormalities in the Emergency Department

Cited by 45 publications

References 27 publications

Risk variables associated with abnormal calcium, magnesium and phosphate levels among emergency department patients

Risk variables associated with abnormal calcium, magnesium and phosphate levels among emergency department patients

Emergency Management of Malignancy-Associated Hypercalcemia

Calcium Metabolism Indicators in Patients with Generalized Periodontitis and Hypertension

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