摘要
The purpose of this study was to identify initial clinical presentations, predisposing disorders, treatment modalities, and prognoses of hypercalcemia in an emergency department (ED). A retrospective review of 172 hypercalcemic adults, out of 2871 serum calcium samplings in the ED, was conducted and analyzed. Most clinical symptoms of patients with hypercalcemia were nonspecific, including general malaise in 86 (50%), altered mental status in 55 (32%), poor appetite in 40 (23%), and bone pain in 31 (18%). Malignancy in 68 (40%) patients, and uremia or renal insufficiency in 31 (18%) patients were the 2 leading underlying diseases associated with hypercalcemia. Serum free calcium levels (FCL) of patients with malignant diseases were higher than those with non-malignant diseases (68 vs. 104 patients; 1.65 ± 0.32 vs. 1.45 ± 0.17 mmol/L, p ＜ 0.01). Of 68 patients with malignancies, 24 patients with bone involvement had a higher FCL than did those without bone involvement (1.76 ± 0.38 vs. 1.59 ± 0.33 mmol/L, respectively, p ＜0.05). Among patients with malignancies, the mean FCLin the 36 patients who died within 3 months was 1.75 ± 0.41 mmol/L, which significantly differed from 1.52 ± 0.23 mmol/L (P＜0.01) in the other 32 survivors. However, no significant correlation was noted between FCL and mortality in patients without malignancies. Severe hypercalcemia (FCL≥1.75mmol/L) was encountered in 8 patients without malignancies, who responded well to clinical management. One hundred and eight (63%) hypercalcemics received calcium0reducing interventions. Of the 55 patients with FCL≥1.50 mmol/L, 52 (95%) of them received such treatments. Out results provide emergency physicians with demographic and clinical data in diagnosing and treating hypercalcemia. For patients with malignancies, a higher FCL may indicate a poor prognosis in spite of aggressive calcium-reducing management.
並列摘要
The purpose of this study was to identify initial clinical presentations, predisposing disorders, treatment modalities, and prognoses of hypercalcemia in an emergency department (ED). A retrospective review of 172 hypercalcemic adults, out of 2871 serum calcium samplings in the ED, was conducted and analyzed. Most clinical symptoms of patients with hypercalcemia were nonspecific, including general malaise in 86 (50%), altered mental status in 55 (32%), poor appetite in 40 (23%), and bone pain in 31 (18%). Malignancy in 68 (40%) patients, and uremia or renal insufficiency in 31 (18%) patients were the 2 leading underlying diseases associated with hypercalcemia. Serum free calcium levels (FCL) of patients with malignant diseases were higher than those with non-malignant diseases (68 vs. 104 patients; 1.65 ± 0.32 vs. 1.45 ± 0.17 mmol/L, p ＜ 0.01). Of 68 patients with malignancies, 24 patients with bone involvement had a higher FCL than did those without bone involvement (1.76 ± 0.38 vs. 1.59 ± 0.33 mmol/L, respectively, p ＜0.05). Among patients with malignancies, the mean FCLin the 36 patients who died within 3 months was 1.75 ± 0.41 mmol/L, which significantly differed from 1.52 ± 0.23 mmol/L (P＜0.01) in the other 32 survivors. However, no significant correlation was noted between FCL and mortality in patients without malignancies. Severe hypercalcemia (FCL≥1.75mmol/L) was encountered in 8 patients without malignancies, who responded well to clinical management. One hundred and eight (63%) hypercalcemics received calcium0reducing interventions. Of the 55 patients with FCL≥1.50 mmol/L, 52 (95%) of them received such treatments. Out results provide emergency physicians with demographic and clinical data in diagnosing and treating hypercalcemia. For patients with malignancies, a higher FCL may indicate a poor prognosis in spite of aggressive calcium-reducing management.