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The Incidence and Risk Factors for Hypercalcemia in Adult Hospitalized Patients Receiving Total Parenteral Nutritional Therapy

摘要


BACKGROUND: Total parenteral nutrition (TPN) has been increasingly used to treat hospitalized malnourished patients. However, TPN therapy also leads to several metabolic and mechanical complications. Hypercalcemia is one of the metabolic complications, and it was seldom discussed before. METHODS: Three hundred and thirty-eight patients who had received TPN therapy at Taipei Cathay General Hospital from January 1, 2013 to June 30, 2014 were retrospectively enrolled. Patients who had hypercalcemia prior to TPN therapy and those who had no serum calcium data before or after TPN therapy were excluded. We collected the baseline demographics, past medical histories, disease severity, nutritional indexes, laboratory data, hospitalized days prior to TPN therapy and TPN prescriptions. Hypercalcemia is defined as at least one corrected serum calcium level > 10 mg/dL. The risk factors for development of hypercalcemia after TPN therapy was analyzed by multiple logistic regression. RESULTS: The mean age of our patients was 68.21 ± 14.92 years, and 53.85% were male. The mean corrected serum calcium level before TPN therapy was 7.51 ± 0.93 mg/dL. The mean TPN treatment duration was 17.55 ± 18.68 days. There were 135 patients developed hypercalcemia after TPN therapy, with an incidence rate of 39.9%. The multivariate analysis showed that Acute Physiology and Chronic Health Evaluation II (APACHE II) ≥ 10 (odds ratio [OR]: 2.83, 95% confidence interval [CI]: 1.38–5.84), hospitalized days prior to TPN therapy (OR: 1.03, 95% CI: 1.001-1.067), and cumulative calcium supply (OR: 1.005, 95% CI: 1.001-1.009) were independent risk factors for hypercalcemia after TPN therapy. A daily phosphate supply greater than 10 mmol (OR: 0.51, 95% CI: 0.27-0.97) was a protective factor for hypercalcemia in TPN. CONCLUSION: Hypercalcemia may occur in patients receiving TPN, with a high incidence rate of 39.9% in our single-center cohort study. Patients with severe illness, longer hospitalized days prior to TPN therapy and greater cumulative calcium supply by TPN were associated with a higher risk for hypercalcemia after TPN therapy. A daily phosphate supply greater than 10 mmol reduces the risk of hypercalcemia. Further studies are required to answer the mechanisms of hypercalcemia after TPN therapy.

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