To study the clinical profile of hypercalcemia patients attending emergency medicine department and their outcome at 6 months of follow up

Abstract

Background: Severe hypercalcemia is a rare but harmful electrolyte disorder in emergency department patients

OBJECTIVES: To study the clinical profile of hypercalcemia patients attending emergency medicine department and their outcome at 6 months of follow up

STUDY DESIGN: Prospective, cross-sectional descriptive study

MATERIAL AND METHODS: Cases include all the patients of hypercalcemia (two serum calcium values more or equal to 10.5mg/dl) who presented to the department of emergency medicine SKIMS.

The evaluation included:

1) Clinical- with focus on presenting signs and symptoms (pre-defined proforma)

2) Biochemical-serum phosphate, albumin, intact-PTH, 25OH (vitamin-D), serum creatinine, 24hrs urinary calcium

Patients were followed for 6 months after discharge

RESULTS: In our prospective cross sectional descriptive study we have studied 100 patients from emergency with hypercalcemia (mean serum calcium=11.79mg/dl). Male: female ratio was 1.4: 1. Clinical presentation was variable but the most common symptom was generalized weakness65 (65%). Commonest cause of hypercalcemia was malignancy 68 (68%), of which most common was haematological malignancy 43 (43%) followed by solid organ malignancies 25 (25%). Other causes were Vitamin D intoxication in 10 (10%), PHPT in 6 (6%), Tuberculosis in 6 (6%), no obvious cause in 10 (10%). Final outcome after 6 month of follow up, serum calcium return to normal with normal eGFR in 36 (36%) of patients, persistently elevated serum calcium with abnormal eGFR in29 (29%) , 35 (35%) of patient died, of which Malignancy was in 28 (28%) of the patients, tuberculosis in 3 (3%) and 4 (4%) were unknown

CONCLUSIONS. Malignancy is the most common cause of hypercalcemia in emergency i.e. 68 (68%)

IMPLICATIONS. Unspecific symptoms such as weakness or change in mental state should prompt physicians to order serum calcium measurements, at least in patients with known malignancy or renal insufficiency to look for hypercalcemia