Abstract
Hypercalcemia is often considered as an emergency because of a potential risk life-threatening arrhythmias or coma. However, there is little evidence, apart from case studies, that hypercalcemia can be immediately life-threatening. The aim of our study was to assess prospectively, if hypercalcemia (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. The primary outcome was the number of life-threatening cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, sinus arrest and 2nd or 3rd degree atrioventricular blocks) or neurological complications defined by a Coma Glasgow Score < 9 during the stay on the ED. The secondary outcomes were correlation between calcium concentrations and ECG QTc intervals, Coma Glasgow Scores and mortality at 7 days and 12 months. Median calcium concentration was 3.3 mmol/L (3.1-3.7). Cancer was the first cause of hypercalcemia. No patient presented a life-threatening cardiac arrhythmia during stay on the ED. Three patients presented a life-threatening neurological complication. There was no correlation between calcemia and QTc intervals or Coma Glasgow Score. Prognosis was poor, 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 which could severely alter mental status such as profound metabolic acidosis.
Published Version
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