Lee Chien-Te, Yang Chih-Chao, Lam King-Kwan, Kung Chia-Te, Tsai Chia-Jung, Chen Hung-Chun
Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taiwan.
Am J Med Sci. 2006 Mar;331(3):119-23. doi: 10.1097/00000441-200603000-00002.
Severe hypercalcemia can be life-threatening. However, its incidence and the underlying causes in the emergency department (ED) have not been determined. In the present study, we investigated these issues and the impacts on renal function and patients' survival.
We performed a retrospective study to analyze the patients with hypercalcemia in the ED for 1 year. Serum total calcium level greater than 10.3 mg/dL was defined as hypercalcemia.
During the study period, 321 of 4293 patients (7.5%) were found to have hypercalcemia (serum calcium 11.7 +/- 1.6 mg/dL). Most of them had mild hypercalcemia (calcium level < 12.0 g/dL, 70.7%). Malignancy (36.4%) and uremia (32.4%) were the most common underlying causes. Normal renal function was observed in only 75 (23.4%) of all patients with hypercalcemia. The total mortality rate was 23.1%, and death was associated with male gender, higher calcium level, lower hemoglobin, and malignancy (all P < 0.05). Logistic analysis found that serum calcium and hemoglobin levels were independent risk factors for mortality.
Severe hypercalcemia is frequently and life-threatening in the ED. Therefore routine determination of serum calcium level is recommended, and immediate therapy should be initiated to treat the patients at high risk.
严重高钙血症可能危及生命。然而，其在急诊科的发病率及潜在病因尚未明确。在本研究中，我们调查了这些问题以及对肾功能和患者生存的影响。
我们进行了一项回顾性研究，分析急诊科1年内高钙血症患者的情况。血清总钙水平大于10.3mg/dL被定义为高钙血症。
在研究期间，4293例患者中有321例（7.5%）被发现患有高钙血症（血清钙11.7±1.6mg/dL）。他们中的大多数患有轻度高钙血症（钙水平<12.0g/dL，70.7%）。恶性肿瘤（36.4%）和尿毒症（32.4%）是最常见的潜在病因。所有高钙血症患者中仅有75例（23.4%）肾功能正常。总死亡率为23.1%，死亡与男性、较高的钙水平、较低的血红蛋白和恶性肿瘤相关（均P<0.05）。逻辑分析发现血清钙和血红蛋白水平是死亡率的独立危险因素。
严重高钙血症在急诊科常见且危及生命。因此，建议常规测定血清钙水平，并应立即对高危患者进行治疗。
