Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients

Mousseaux, Cyril; Dupont, Axelle; Rafat, Cédric; Ekpe, Kenneth; Ghrénassia, Étienne; Kerhuel, Lionel; Ardisson, Fanny; Mariotte, Éric; Lemiale, Virginie; Schlemmer, Benoı̂t; Azoulay, Élie; Zafrani, Lara

doi:10.1186/s13613-019-0606-8

Cited by 28 publications

(31 citation statements)

References 40 publications

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“…In one study published in the Journal of Leukemia and Lymphoma , the presence of hypercalcemia in patients with newly diagnosed diffuse large B cell lymphoma was found to be 18% [ 13 ]. In a study published in Annals of Intensive Care in 2019, the hematological malignancies were the contributing cause of hypercalcemia in 44.3% of patients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Malignant and Non-Malignant Causes of Hypercalcemia: A Retrospective Study at a Tertiary Care Hospital in Pakistan

Banu¹,

Batool²,

Sattar³

et al. 2021

Cureus

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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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Section: Discussionmentioning

confidence: 99%

Malignant and Non-Malignant Causes of Hypercalcemia: A Retrospective Study at a Tertiary Care Hospital in Pakistan

Banu¹,

Batool²,

Sattar³

et al. 2021

Cureus

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“…These patients had a higher incidence of sepsis, shock, renal failure, and secondary hypercalcemia due to immobilization and consequent bone remodelling. 4,5…”

Section: Hypercalcemia In Critical Illnessmentioning

confidence: 99%

“…Hypercalcemia is more common in patients with early acute kidney injury (AKI), and the number of organs failing is the best predictor of occurrence of later hypercalcemia. 5,7 Drug therapy can also contribute to hypercalcemia. Lithium therapy can induce hypercalcemia and, therefore, regular monitoring is important.…”

Section: Causesmentioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

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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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“…Therefore, it is extremely important to accurately and effectively judge the severity and prognosis of COVID-19 infection. Abnormal calcium metabolism is one of the important and common electrolyte disturbances in patients with severe infection, the effect of blood calcium level on the severity of COVID-19 and the possible immune regulation mechanism is yet to be determined [8].…”

Section: Introductionmentioning

confidence: 99%

Relationship of Hypocalciamia and Severity of Disease in COVID-19 Patients in Lahore Pakistan

Hamid¹,

Shah²,

Rasool³

et al. 2021

AJBLS

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Introduction: In Pakistan, a wave of coronavirus has started in February which was first reported in Wahun City China. Abnormal calcium blood level is considered one of the important and common electrolyte disturbances in patients with severe infection. The effect of blood calcium level on the severity of COVID-19 and the possible immune regulation mechanism is considered to be an important factor related to severity of disease. Aim of the Study: To find out the correlation of blood calcium levels and related risk factors of patients suffering from COVID-19 and provide a basis for early intervention in patients with relevant clinical characteristics and further reduce the incidence of critical illness and mortality in COVID-19 patients. Method: 180 COVID-19 patients were admitted to Gulab Devi Teaching Hospital, Lahore between February to July 2020. Subject index were tested on real-time fluorescent RT-PCR test. On the basis of the result of RT-PCR, they were divided into two groups according to clinical symptoms as mild (control/placebo group) and critical (experimental group). The patient with the mild symptom were included in the placebo group, whereas patient with the severe symptoms were included in the experimental group. Exclusion criteria: The patients who do not show the detection level of viral infection with the RT-PCR are excluded from the study. Results: The comparison has been carried out between the placebo group and the experimental group on the basis of various parameters. The patients serum calcium level was tested and the value for hypocalcemia was declared as per universal recommendation which is < 2.13mmol/L. According to the corrected serum total calcium level, COVID-19 patients can be divided into hypocalcemia group and normal blood calcium group. The result showed that hypocalcemia and immune dysfunction was found high in experimental group as compare to control group which shows a strong correlation between hypocalcemia and COVID-19 disease. Conclusion: It has been concluded from the study that patients with COVID-19 have obvious hypocalcemia and immune dysfunction, especially in experimental group patients. In this study, it is easy to be combined with multiple infections caused by pathogenic bacteria under certain conditions. Close monitoring of blood calcium levels can predict the severity of the disease more effectively.

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Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients

Cited by 28 publications

References 40 publications

Malignant and Non-Malignant Causes of Hypercalcemia: A Retrospective Study at a Tertiary Care Hospital in Pakistan

Malignant and Non-Malignant Causes of Hypercalcemia: A Retrospective Study at a Tertiary Care Hospital in Pakistan

Metabolic and Endocrine Challenges

Relationship of Hypocalciamia and Severity of Disease in COVID-19 Patients in Lahore Pakistan

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