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严重高钙血症是否立即危及生命?

Is severe hypercalcemia immediately life-threatening?

机构信息

Departments of Emergency Medicine.

Nephrology, Nantes University Hospital, Nantes Cedex 01, France.

出版信息

Eur J Emerg Med. 2018 Apr;25(2):110-113. doi: 10.1097/MEJ.0000000000000462.

Abstract

OBJECTIVE

Severe hypercalcemia is often considered an emergency because of a potential risk of cardiac arrest or coma. However, there is little evidence to support this. The aim of our study was to assess whether severe hypercalcemia (Ca>4 mmol/l or 16 mg/dl) was associated with immediately life-threatening cardiac arrhythmias or neurological complications in patients admitted to the Emergency Department (ED).

METHODS

A retrospective observational study was carried out over a 5-year period (2008-2012). Eligible patients were admitted to the Adult Emergency Department of Nantes University Hospital and had a calcium concentration in excess of 4 mmol/l. There were no exclusion criteria. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED. The secondary outcomes were correlation between calcium concentrations/ECG QTc intervals and mortality.

RESULTS

A total of 126 204 adult patients had calcium concentrations measured. Thirty one (0.025%) patients had severe hypercalcemia as defined in our study. The median calcium concentration was 4.3 mmol/l (Q1, 4.2; Q3, 4.7) and the median albumin-adjusted calcium concentration was 4.3 mmol/l (Q1, 4.1; Q3, 4.7). No patient presented with a life-threatening cardiac event during stay in the ED. The median ED stay was 7 h 32 min. One patient presented with a coma of multifactorial origin. There was no correlation between calcemia and QTc intervals (P=0.60). Mortality at 1 year was 55% (17 patients).

CONCLUSION

We found no cases of immediately life-threatening cardiac arrhythmias or neurological complications associated with hypercalcemia above 4 mmol/l over a 5-year period in a large tertiary ED.

摘要

目的

由于潜在的心脏骤停或昏迷风险,严重高钙血症通常被认为是一种紧急情况。然而,几乎没有证据支持这一点。我们的研究旨在评估在急诊科(ED)就诊的患者中,严重高钙血症(Ca>4mmol/l 或 16mg/dl)是否与立即危及生命的心律失常或神经并发症相关。

方法

进行了一项为期 5 年的回顾性观察性研究(2008-2012 年)。符合条件的患者被收入南特大学医院成人急诊病房,钙浓度超过 4mmol/l。没有排除标准。主要结局是 ED 住院期间危及生命的心律失常和/或神经并发症的数量。次要结局是钙浓度/ECG QTc 间隔与死亡率之间的相关性。

结果

共有 126204 名成年患者的钙浓度进行了测量。31 名(0.025%)患者出现了我们研究中定义的严重高钙血症。中位钙浓度为 4.3mmol/l(Q1,4.2;Q3,4.7),中位白蛋白校正钙浓度为 4.3mmol/l(Q1,4.1;Q3,4.7)。在 ED 住院期间,没有患者出现危及生命的心脏事件。ED 中位住院时间为 7 小时 32 分钟。一名患者出现多因素来源的昏迷。钙血症与 QTc 间隔之间无相关性(P=0.60)。1 年死亡率为 55%(17 例)。

结论

在 5 年内,我们在一个大型三级 ED 中未发现 4mmol/l 以上高钙血症与立即危及生命的心律失常或神经并发症相关的病例。

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