Trewick David, Le Borgne Mathilde, Regnault Julie, Guimard Camille
Endocr Connect. 2025 Jan 27;14(2). doi: 10.1530/EC-24-0508. Print 2025 Feb 1.
Hypercalcaemia is often considered as an emergency because of a potential risk of life-threatening arrhythmias or coma. However, there is little evidence, apart from case studies, that hypercalcaemia can be immediately life-threatening. The aim of our study was to prospectively assess whether hypercalcaemia (Ca ≥ 3 mmol/L) was associated with immediately life-threatening complications.
We conducted a prospective observational study aiming to include the first one hundred patients aged ≥18 who had a calcium concentration ≥3 mmol/L, admitted to the emergency department (ED). The primary outcome was the number of life-threatening cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, sinus arrest and second- or third-degree atrioventricular blocks) or neurological complications defined by a Glasgow Coma Scale score <9 during the stay in the ED. The secondary outcomes were correlation between calcium concentrations and ECG (electrocardiogram) QTc intervals, Glasgow Coma Scale scores and mortality during the following 12-month follow-up period.
The median calcium concentration was 3.3 mmol/L (3.1-3.7). Cancer was the first cause of hypercalcaemia. No patient presented a life-threatening cardiac arrhythmia during their stay in the ED. Three patients presented a life-threatening neurological complication. There was no correlation between calcaemia and QTc intervals or Glasgow Coma Scale score. Prognosis was poor, and 43 patients died during the 12 months.
We found no cases of immediately life-threatening cardiac arrhythmias. Three patients had indeed a life-threatening neurological complication but always had at least one other major factor that could severely alter mental status, such as profound metabolic acidosis.
This paper aims to revisit what most physicians, whether specialists or not, consider to be scientifically proven facts concerning the immediate threat caused by hypercalcaemia. Its novelty is threefold: first, this is the only prospective study that exists to date studying the life-threatening consequences of hypercalcaemia; second, having included one hundred patients, we found no life-threatening cardiac arrhythmias, which is not what would be expected if one reads guidelines concerning hypercalcaemia; and third, life-threatening neurological complications were very rare and only occurred in patients with at least one other major cause of altered neurological status, such as severe metabolic acidosis or hypernatraemia.
高钙血症常被视为一种急症，因为存在危及生命的心律失常或昏迷的潜在风险。然而，除了病例研究外，几乎没有证据表明高钙血症会立即危及生命。我们研究的目的是前瞻性评估高钙血症（血清钙≥3 mmol/L）是否与立即危及生命的并发症相关。
我们进行了一项前瞻性观察性研究，旨在纳入首批100名年龄≥18岁、血清钙浓度≥3 mmol/L且入住急诊科（ED）的患者。主要结局是在急诊科住院期间危及生命的心律失常（室性心动过速、心室颤动、窦性停搏以及二度或三度房室传导阻滞）的数量，或格拉斯哥昏迷量表评分<9所定义的神经系统并发症。次要结局是血清钙浓度与心电图（ECG）QTc间期、格拉斯哥昏迷量表评分以及接下来12个月随访期内死亡率之间的相关性。
血清钙浓度中位数为3.3 mmol/L（3.1 - 3.7）。癌症是高钙血症的首要病因。在急诊科住院期间，没有患者出现危及生命的心律失常。3名患者出现了危及生命的神经系统并发症。血钙水平与QTc间期或格拉斯哥昏迷量表评分之间无相关性。预后较差，43名患者在12个月内死亡。
我们未发现立即危及生命的心律失常病例。确实有3名患者出现了危及生命的神经系统并发症，但他们总是至少有一个其他可严重改变精神状态的主要因素，如严重代谢性酸中毒。
本文旨在重新审视大多数医生（无论是否为专科医生）认为的关于高钙血症所致直接威胁的科学已证实事实。其新颖之处有三点：第一，这是迄今为止唯一一项研究高钙血症危及生命后果的前瞻性研究；第二，纳入了100名患者，我们未发现危及生命的心律失常，这与阅读高钙血症相关指南时的预期不符；第三，危及生命的神经系统并发症非常罕见，且仅发生在至少有一个其他导致神经系统状态改变的主要病因的患者中，如严重代谢性酸中毒或高钠血症。
