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

Abstract

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.

Identification of Predictors of Abnormal Calcium, Magnesium and Phosphorus Blood Levels in the Emergency Department: A Retrospective Cohort Study

“…Some risk factors differ between our studies, but corroborate with the following: chemotherapy (stated as anti-neoplastic medication in our study) for hypocalcemia, diabetes for hypomagnesemia, chronic kidney disease for hypermagnesemia and hyperphosphatemia and seizure for hypophosphatemia. 19 …”

“…Some risk factors differ between our studies, but corroborate with the following: chemotherapy (stated as antineoplastic medication in our study) for hypocalcemia, diabetes for hypomagnesemia, chronic kidney disease for hypermagnesemia and hyperphosphatemia and seizure for hypophosphatemia. 19 In 2013, Lindner et al published their work on the demographic and clinical characteristics of hypercalcemia in the ED. Their retrospective cohort study included 14,984 patients for whom serum calcium levels had been electively drawn by ED physicians.…”

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

“…10,11 In patients with severe food intolerance and concomitant proton pump inhibitor usage, evaluation should include testing for magnesium and calcium deficiency. 12 Patients often have higher depression and anxiety scores, as well as a lower physical quality of life, and medical teams sometimes neglect the patients' psychological state. 13 It is imperative that the multidisciplinary team recognize and acknowledge the patients psychological comorbidities and engage expertise to manage them.…”

Alterations of Serum Magnesium Concentration in Animal Models of Seizures and Epilepsy—The Effects of Treatment with a GPR39 Agonist and Knockout of the Gpr39 Gene

“…Variants of the TRPM6 gene-another TRP channel belonging to subfamily M, which is a close homolog of TRPM7 [31]-caused hypomagnesaemia accompanied by seizures [32]. Two recent studies did not find seizures as a significant risk factor for hypomagnesaemia [33,34], but seizures are among the neurological symptoms that may occur in those with severe hypomagnesaemia [35,36]. A meta-analysis of 40 studies showed that the serum magnesium concentrations were not different between epilepsy patients and control subjects, but hair magnesium concentrations were lower in both treated and non-treated patients compared to controls.…”