Corrected Serum Calcium Levels Research Articles

7027 A Rare And Multifactorial Etiology Of Severe Parathyroid Hormone Independent Hypercalcemia In An Adult Female With Rett Syndrome

Abstract Disclosure: M.I. Foo: None. M. Thompson: None. Background: Symptomatic hypercalcemia is a rare, but potentially life-threatening disorder. Although dehydration is an unusual cause of severe hypercalcemia, in the appropriate clinical setting dehydration may amplify underlying mild or moderate hypercalcemia to dangerous levels.Case: A 46-year-old non-verbal, non-mobile Caucasian female with Rett Syndrome (RS) with Stage III Chronic Kidney Disease (CKD3) who is dependent on percutaneous endoscopic gastrostomy (PEG) tube for nutrition and known PTH independent hypercalcemia of unknown etiology presented to the hospital with intractable vomiting and constipation, an outpatient serum calcium level of 16.0 mg/dL, and serum creatinine 4.03 mg/dL (baseline 1.2 mg/dL). Initial laboratory assessment revealed elevated corrected serum calcium levels (15.7 mg/dL), with appropriately suppressed PTH levels (12.5 pg/mL) and hypernatremia (146 mmol/L). Thyroid function tests, both Vitamin D 1,25(OH)2D and D 25(OH)D levels and PTH-RP were normal. Computed tomography of the abdomen and pelvis revealed bilateral nephrolithiasis and moderate stool burden, but no evidence of malignancy or granulomatous disease. Skeletal scintigraphy was also without evidence of osseous metastatic disease or Paget’s disease of bone. An in-depth interview with the patient’s caregiver uncovered that the patient had a relative intolerance to enteral hydration and had been receiving minimal water flushes prior to admission, contributing to severe dehydration. Hypercalcemia was ultimately ascribed to prolonged immobilization due to RS compounded by inadequate fluid intake and auto-diuresis secondary to hypercalciuria in the setting of CKD (prior baseline eGFR 45 mL/min/1.73m2).Outcome: The patient's hypercalcemia improved after a multidisciplinary and multi-directed approach involving intravenous and enteral fluid resuscitation, calcitonin, furosemide, and ultimately zoledronic acid following improvement in creatinine with fluid resuscitation. The dietary service employed a strategy of 24-hour enteral feeding, increasing both the frequency and amount of enteral water, which the patient tolerated well, and provided her with a new pump for home use. Education on monitoring tube feed tolerance and providing adequate enteral hydration was provided to both the caregiver and group home. On discharge, eGFR stabilized at 33 mL/min/1.73m2 and corrected calcium stabilized at 10.0–10.4 mg/dl. She was provided with an endocrinology follow-up to continue bisphosphonate therapy.Discussion: Hypercalcemia of immobility should remain a differential diagnosis in severe hypercalcemia, especially PEG tube dependent patients with underlying kidney disease. This case highlights the importance of thorough history taking and a multidisciplinary strategy to guarantee optimal care and mitigate potential adverse outcomes in medically complex patients. Presentation: 6/2/2024

Association of serum calcium levels with diabetic kidney disease in normocalcemic type 2 diabetes patients: a cross-sectional study

To explore the association between serum calcium levels within normal ranges and Diabetic Kidney Disease (DKD) in type 2 diabetes patients. In this cross-sectional study, we analyzed clinical data from type 2 diabetes patients admitted to the Endocrinology Department of the Affiliated Hospital of Qingdao University from January 1, 2021, to December 1, 2022. We measured serum calcium levels, corrected for albumin, and screened for diabetes-related complications, including DKD. The association between corrected serum calcium levels and DKD was evaluated using logistic regression, with adjustments made for potential confounders and a generalized additive model (GAM) to explore non-linear relationships, supplemented by subgroup analyses. Among the 3016 patients (52.55% male, 47.45% female), the mean corrected serum calcium was 2.29 ± 0.08 mmol/L. DKD was present in 38.73% of patients. A 0.1 mmol/L increase in corrected serum calcium was associated with a 44% increased risk of DKD (OR = 1.44, 95% CI 1.28–1.61, p < 0.0001). The GAM indicated a linear relationship between corrected serum calcium and DKD risk, consistent across subgroups. Corrected serum calcium levels were linearly associated with DKD risk in type 2 diabetes patients, underlining its potential role in risk assessment. These findings emphasize the clinical importance of monitoring serum calcium levels. However, the need for further prospective studies to confirm these findings is underscored by the study’s cross-sectional design.

Estimating the prevalence of hypocalcemia in adults presenting with new-onset seizures: A cross-sectional study

Background. Approximately 8% to 10% of the population will experience a seizure during their lifetime. Only about 2% to 3% of patients go on to develop epilepsy. Common metabolic causes include hypoglycemia, hyperglycemia, hyponatremia, hypocalcemia, hypomagnesemia, etc. Hypocalcemia in particular is often implicated in neonates and younger children. The present study was aimed at estimating the prevalence of hypocalcemia in adults (&gt;18 years of age) presenting with new onset seizures. Material and methods. Our study was a cross-sectional, prospective, observational study, conducted in patients aged more than 18 years of age of either sex who presented with at least 1 episode of acute (&lt;24 hours) new onset seizures. A total of 72 patients were included in the study, who satisfied the inclusion and exclusion criteria. Venous blood was collected in a red top plastic tube, containing no anticoagulants and used for laboratory testing. Results. During the study period, 72 patients with new-onset seizures were considered for the present study. The mean age of the study population was 44.73±12.45 years. The mean serum calcium level was 8.13±0.53 mg/dL. Serum calcium level less than 8.5 mg/dL was noted in 32 cases (44.44 %). A level in the normal range (8.5-10 mg/dl) was noted in 40 patients (55.56 %). A serum albumin level of less than 3 gm % was noted in 7 patients (9.72 %). The mean corrected serum calcium level was 8.23±0.71 mg/dL. Among 72 patients, a corrected serum calcium level of less than 8.5 mg/dL was noted in 31 cases. Thus, the prevalence of hypocalcemia in adults presenting with new-onset seizures was 43.05%. There was no significant difference noted for age and gender among hypocalcemic and normocalcemic cases (p&gt;0.05). Conclusion. In patients presenting with new onset seizures, the prevalence of hypocalcemia was found to be 43%. Further studies are required to prove definite causality. However, we recommend checking serum calcium levels, along with the other electrolytes for all patients presenting with new onset seizures and correcting them as required.

Calcium – a possible element behind hypertension

Background. Hypertension is the one of the important reasons of mortality and morbidity worldwide which affects around 6% to 32% of the general population. It has been documented that the serum calcium level has the impact on cardiovascular functions. Patients with essential hypertension display altered calcium metabolism, including elevated cytosolic calcium, reduced serum calcium levels and augmented urine excretion of calcium. Therefore, this study was undertaken in the direction for evaluate the link of calcium in newly diagnosed hypertensive patients. Materials and methods. This cross-sectional study was conducted in isolated newly diagnosed essential Hypertensive subjects who came to the hypertensive OPD, who were free from any other illness or under any medication. 100 cases and 50 controls were included in this study. Body mass index, Blood pressure and serum calcium levels were evaluated in the enrolled subjects. Student's t test and chi-square test were used for statistical analysis. Results. The mean serum calcium in newly diagnosed hypertensive group was 8.35 ± 1.04 and in control group it was 10.04 ± 0.66. The mean corrected calcium in newly diagnosed hypertensive group was 8.40 ± 1.01 and in control group it was 9.87 ± 4.76. These results were highly statistically significant p=0.000. Negative correlation was found between serum calcium and blood pressure among our subjects. Conclusion. Patients with essential hypertension had lower corrected serum calcium levels, and there was a substantial inverse association (negative correlation) between corrected serum calcium levels and blood pressures. So, while treating patients with hypertension, more attention to be given for the serum calcium levels.

Vitamin D deficiency as a risk factor for sudden cardiac arrest: A multicenter case-control study

Background and aimsVitamin D is known to influence the risk of cardiovascular disease, which is a recognized risk factor for sudden cardiac arrest (SCA). However, the relationship between vitamin D and SCA is not well understood. Therefore, this study aims to investigate the association between vitamin D and SCA in out-of-hospital cardiac arrest (OHCA) patients compared to healthy controls. Methods and resultsUsing the Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES II) registry, a 1:1 propensity score-matched case-control study was conducted between 2017 and 2020. Serum 25-hydroxyvitamin D (vitamin D) levels in patients with OHCA (454 cases) and healthy controls (454 cases) were compared after matching for age, sex, cardiovascular risk factors, and lifestyle behaviors. The mean vitamin D levels were 14.5 ± 7.6 and 21.3 ± 8.3 ng/mL among SCA cases and controls, respectively. Logistic regression analysis was used adjusting for cardiovascular risk factors, lifestyle behaviors, corrected serum calcium levels, and estimated glomerular filtration rate (eGRF). The adjusted odds ratio (aOR) for vitamin D was 0.89 (95% confidence interval [CI] 0.87–0.91). The dose-response relationship demonstrated that vitamin D deficiency was associated with SCA incidence (severe deficiency, aOR 10.87, 95% CI 4.82–24.54; moderate deficiency, aOR 2.24, 95% CI 1.20–4.20). ConclusionVitamin D deficiency was independently and strongly associated with an increased risk of SCA, irrespective of cardiovascular and lifestyle factors, corrected calcium levels, and eGFR.

Predictive analysis of severe hypocalcemia following total parathyroidectomy for renal secondary hyperparathyroidism.

This study aimed to evaluate the incidence and identify risk factors for severe hypocalcemia following total parathyroidectomy (TPTX) in patients with renal secondary hyperparathyroidism (SHPT). We included patients undergoing maintenance hemodialysis or peritoneal dialysis who underwent TPTX from January 1, 2018, to April 30, 2023. Participants were categorized into groups based on postoperative corrected serum calcium levels: severe hypocalcemia (<1.8 mmol/L) and non-severe hypocalcemia (≥1.8 mmol/L). We conducted univariate analyses of demographic and laboratory data to identify potential risk factors, which were further analyzed using a binary logistic regression model. Significant associations were observed with age, dialysis duration exceeding five years, type of dialysis (peritoneal dialysis), lower preoperative corrected serum calcium, elevated preoperative intact parathyroid hormone (iPTH), and increased preoperative alkaline phosphatase (ALP) levels (all p<0.05). Age, preoperative iPTH, and ALP levels were identified as independent risk factors for severe hypocalcemia post-TPTX. Younger patients with renal SHPT who have elevated preoperative iPTH and ALP levels are at an increased risk of experiencing severe hypocalcemia following TPTX. These findings underscore the importance of careful preoperative assessment and monitoring to mitigate the risk of this complication.

Correlation of Serum Calcium with Components of Metabolic Syndrome: A Cross-sectional Study

Introduction: Metabolic syndrome is a cluster of symptoms following impaired glucose tolerance, adiposity, abnormal lipid profiles and hypertension. Metabolic syndrome may serve as a precursor for type II diabetes mellitus and cardiovascular diseases. Therefore, it should be considered when interpreting calcium levels, as calcium is inexpensive, readily available and can also serve as a predictor for diabetic and cardiovascular risks. Aim: To investigate the correlation of serum calcium with components of metabolic syndrome. Materials and Methods: A cross-sectional study was conducted in the Department of Biochemistry, Government Medical College and General Hospital, Aurangabad, Maharashtra, India, from January 2016 to March 2016. A total of 80 patients were divided into two groups: subjects with metabolic syndrome (group I) and subjects without metabolic syndrome (group II). Data including age and components of metabolic syndrome such as Body Mass Index (BMI), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Waist Circumference (WC) and various biochemical parameters {plasma glucose, calcium, albumin, corrected calcium, total cholesterol, Triglycerides (TG), High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL)}. were collected and compared between the two groups. The differences in the studied variables among the groups were analysed using an Unpaired t-test. A p-value less than 0.05 was considered statistically significant. Results: In the present study, group I consisted of 23 males and 17 females with the mean±Standard Deviation (SD) age 49.88±8.7 years and group II had 19 males and 21 females with mean age 47.5±7.60 years. There were no significant differences in age, gender and blood pressure, while BMI and WC were significantly higher in group I. Serum calcium, fasting plasma glucose levels, and lipid profiles were significantly higher in subjects with metabolic syndrome compared to those without metabolic syndrome. Additionally, serum corrected calcium levels showed a positive correlation with serum TG and fasting plasma glucose (r-value=0.4, p-value=0.008), and a negative correlation with HDL-cholesterol (HDL-C) (r-value=- 0.3, p-value=0.03). Conclusion: In the present study, serum total calcium was found to be positively associated with metabolic syndrome. Estimation of serum calcium can help predict the risk of developing cardiovascular diseases or diabetes mellitus, which are associated with the metabolic syndrome.

Changes in bone and mineral homeostasis after short-term androgen deprivation therapy with or without androgen receptor signalling inhibitor – substudy of a single-centre, double blind, randomised, placebo-controlled phase 2 trial

Prostate cancer (PCa) patients treated with androgen deprivation therapy (ADT) have an increased fracture risk. Exploring biomarkers for early bone loss detection is of great interest. Pre-planned substudy of the ARNEO-trial (NCT03080116): a double blind, randomised, placebo-controlled phase 2 trial performed in high-risk PCa patients without bone metastases between March 2019 and April 2021. Patients were 1:1 randomised to treatment with gonadotropin-releasing hormone antagonist (degarelix)+androgen receptor signalling inhibitor (ARSI; apalutamide) versus degarelix+matching placebo for 12 weeks prior to prostatectomy. Before and following ADT, serum and 24-h urinary samples were collected. Primary endpoints were changes in calcium-phosphate homeostasis and bone biomarkers. Of the 89 randomised patients, 43 in the degarelix+apalutamide and 44 patients in the degarelix+placebo group were included in this substudy. Serum corrected calcium levels increased similarly in both treatment arms (mean difference+0.04mmol/L, 95% confidence interval, 0.02; 0.06), and parathyroid hormone and 1,25-dihydroxyvitamin D3 levels decreased. Bone resorption markers increased, and stable calcium isotope ratios reflecting net bone mineral balance decreased in serum and urine similarly in both groups. This exploratory substudy suggests that 12 weeks of ADT in non-metastatic PCa patients results in early bone loss. Additional treatment with ARSI does not seem to more negatively influence bone loss in the early phase. Future studies should address if these early biomarkers are able to predict fracture risk, and can be implemented in clinical practice for follow-up of bone health in PCa patients under ADT. Research Foundation Flanders; KU Leuven; University-Hospitals-Leuven.

SAT217 Chronic Asymptomatic Hypoparathyroidism Due To Two Separate Single Nucleotide Heterozygous Mutations In The CaSR Gene

Abstract Disclosure: M. Antony: None. S. Gundlapally: None. S. Storm: None. P. Russell: None. V. Verma: None. R. Kant: None. Introduction: The most common cause for acquired hypoparathyroidism is either post-surgical or autoimmune destruction of the parathyroid glands. The clinical presentation can range from an asymptomatic state to severe life-threatening symptoms that require intensive therapeutic management with intravenous and/or oral calcium, calcitriol and in some cases, recombinant parathyroid hormone therapy. Hypoparathyroidism secondary to CASR (calcium sensing gene receptor) gene mutation is an uncommon etiology that can also have a varied clinical presentation as above. Clinical Case: A 60-year-old Caucasian male with no significant past medical history was found to have chronic hypocalcemia. He denied experiencing symptoms such as numbness, tingling or cramping sensation around face, lips, or upper extremities. He denied a history of movement disorder or dental problems. He denied a history of neck surgeries or neck radiation exposure. He denied a family history of calcium disorders. He was on calcium carbonate/Vitamin D3 600 mg/400 I.U once daily. The first documented low corrected serum calcium was 6.9 mg/dl (8.6-10.0 mg/dl) in November of 2017. Since then, there have been multiple low corrected serum calcium levels ranging between 7 to 7.6 mg/dl. Patient underwent endocrinology work-up after withholding the above calcium/Vitamin D3 supplementation and it revealed a low corrected serum calcium of 7.6 mg/dl with an inappropriately normal serum PTH level of 37 pg/ml (15-65 pg/ml), normal vitamin D level of 45.1 ng/ml (&amp;gt; 30.0 ng/ml), normal serum phosphorus 3.8 mg/dl (2.5-4.5 mg/dl), and normal serum magnesium 1.8 mg/dl (1.6-2.6 mg/dl). The 24-hour urine calcium was 93 mg/24 hour with a corresponding 24-hour urine creatinine of 1836 mg (1040-2350 mg/24hour) and urine volume of 1625 ml. CASR gene analysis revealed two separate single nucleotide heterozygous mutations. The first mutation was at Exon 4/7, nucleotide position was c.614G&amp;gt;A and Amino Acid position was p.Arg205His. The second mutation was at Exon 7/7, nucleotide position was c.2546T&amp;gt;C and Amino Acid Position is p.lle849Thr. Due to lack of specific symptoms, patient was not initiated on specific therapies such as calcitriol or Natpara (recombinant PTH) and was advised to continue taking the daily calcium/vitamin D3 supplementation. He is being currently monitored every 4 to 6 months to assess for any clinical symptoms along with pertinent laboratory work-up. Conclusion: Hypoparathyroidism due to CASR gene mutation has a varied clinical presentation. One-third of cases do not develop any clinical symptoms, such as our patient and hence do not warrant any specific treatment other than periodic clinical and biochemical assessment. Presentation: Saturday, June 17, 2023

Assessment of thyroid and parathyroid function in patients treated for laryngeal carcinoma

Background The close proximity of both thyroid and parathyroid glands to the larynx puts them at high risk to develop hypofunction from the treatment of cancer larynx. Aim Thyroid and parathyroid function evaluation after treatment modalities of cancer larynx. Patients and methods Thyroid and parathyroid function was evaluated in 60 patients treated from laryngeal carcinoma. Patients were classified into three groups based on treatment type. Group 1 included patients with primary radiotherapy while group 2 included patients with total laryngectomy and group 3 involved patients with combined total laryngectomy and postoperative radiotherapy. Laboratory assessment of thyroid function included thyroid-stimulating hormone (TSH), free T4, while parathyroid function included corrected serum calcium and parathormone levels. The association of gland hypofunction was studied against tumor and treatment characteristics. Results Among the 60 patients; group 1 included 27 patients, group 2 included 21 patients, and group 3 included 12 patients. Twenty-five (41.7%) patients showed high TSH level and low FT4 level indicating clinical hypothyroidism while 12 (20%) patients showed high TSH level with normal FT4 level indicating subclinical hypothyroidism. Twenty-three (38.3%) patients showed normal levels of both TSH and FT4 being euthyroid. Concerning parathyroid function; 19 (31.7%) showed hypoparathyroidism diagnosed by low corrected serum calcium level and confirmed by low parathyroid hormone level. Conclusion The study detects the occurrence of hypothyroidism with or without hypoparathyroidism after treatment modalities of cancer larynx emphasizing the need of high clinical suspicion and routine evaluation for early detection of any post treatment thyroid or parathyroid gland hypofunction.

Hypervitaminosis D induced hypercalcemia leading to coma: A case report

An elderly female presented with abdominal pain, vomiting and easy fatigability. Her sensorium gradually declined and became comatose. She was on Methotrexate, folic acid and prednisolone for her rheumatoid arthritis. The neurological examination and neuroimaging did not contribute in making the diagnosis. It is challenging to diagnose a metabolic cause of coma. Once diagnosis is established, the management becomes easier. On detailed investigation, she was found to have severe hypercalcemia with corrected serum calcium level being 18.2 mg%. Serum vitamin D level was also high, 150 ng/ml. On probing for detailed history, it was revealed that she had been taking a weekly dose of 60,000 IU of vitamin D for nearly 5 years. In recent times, association of various diseases has been reported with vitamin D deficiency. Vitamin D supplementation seems justified in this patient considering her age and the fact that she had rheumatoid arthritis; she was also taking corticosteroid. The recommended dose of vitamin D has been 400–800 IU/day. However, it is often prescribed at a dose of 60,000 IU/week, and sometimes patients self-medicate. There are no guidelines available for prescribing vitamin D at such a strength. Though safety of vitamin D has been established, vitamin D toxicity can occur sporadically with serious consequences. This was managed with intravenous fluids and diuretics. The patient also required subcutaneous calcitonin and low dose of corticosteroid, in addition to a session of haemodialysis for her hypercalcemia. The patient’s sensorium gradually improved as her calcium level returned to normalcy.

Association between corrected serum calcium levels after dialysis and post-dialysis fatigue risk: a hospital-based case–control study

ObjectivePost-dialysis fatigue (PDF) is an important problem in patients undergoing maintenance hemodialysis (MHD); however, evidence of the association between serum calcium after dialysis and the risk of PDF is limited and controversial. We explored this association among patients receiving MHD.MethodsWe carried out a case–control study of patients in the dialysis unit of Dalian Municipal Central Hospital between December 2019 and January 2020, including 340 patients with PDF and 270 patients without PDF. PDF was assessed by a \\validated self-administered questionnaire. Clinical variables were tested for multicollinearity using variance inflation factor analysis. Corrected serum calcium levels were categorized into three groups, with the lowest tertile used as the reference category. The odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for PDF risk were estimated using an unconditional logistic regression model.ResultAfter adjusting for potential confounders, corrected serum calcium levels showed a significant positive association with the risk of PDF (ORT3vs.T1 = 1.61, 95% CI = 1.01–2.58). Notably, after stratification by age, corrected serum calcium was also positively associated with the risk of PDF in patients aged ≥ 65 years (ORT3vs.T1 = 4.25, 95% CI 1.66–11.46). Furthermore, a significant linear trend and interaction were also observed (P < 0.05).DiscussionHigher corrected serum calcium levels after dialysis might increase the risk of PDF among MHD patients. However, further studies are warranted to confirm these findings.

Effect of adjunct Vitamin D treatment in vitamin D deficient pulmonary tuberculosis patients: A randomized, double blind, active controlled clinical trial

BackgroundSince, Vitamin D [1α,25(OH)2D)] enhances antimicrobial activity of Innate immunity and modulate Adaptive immune responses, simultaneously, so it play a potential role for balanced immune activity against Mycobacterium tuberculosis and restricting tissue injuries within the TB patients.(Chun et al., 2011) 9 We aimed to determine the role of adjunct Vitamin D treatment on the outcome of pulmonary tuberculosis patients and evaluated the effect of Vitamin D administration on Differential Leucocyte Count, Erythrocyte Sedimentation Rate, serum Adenosine deaminase, serum C- reactive protein, Oxygen saturation (SpO2) and Body Weight in Vitamin D deficient pulmonary tuberculosis patients. MethodsWe conducted a prospective, interventional, randomized, double blind, parallel group, active controlled clinical trial. Newly diagnosed Vitamin D deficient pulmonary tuberculosis patients were randomly assigned to intervention group (received standard anti-tubercular treatment with adjunct Vitamin D3) and control group (received standard anti-tubercular treatment without adjunct Vitamin D3). Total four doses [each dose of 2.5 mg (100000 IU)] of Vitamin D3 were given, orally. First dose was given within 7 days of starting anti-tubercular treatment and second, third, fourth dose were given at 2, 4 and 6 weeks respectively. At the time of enrollment, we measured all baseline characteristics. During follow-up, we measured the study variables and monitored adverse events at 2, 4, 6, 8 and 12 weeks. Our safety parameter was serum corrected calcium level to assess the risk of hypercalcemia. ResultsTotal 130 pulmonary TB patients, 65 patients in each group, were analyzed. Our study results showed that decrease in Neutrophil count was statistically significant with small effect sizes at every time point of measurement and increase in Lymphocyte count was statistically significant with small and moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Decrease in erythrocyte sedimentation rate was statistically significant with small effect sizes at 6 and 8 week, decrease in serum adenosine deaminase and serum C- reactive protein was statistically significant with moderate effect sizes at 4, 6 and 8 week for intervention group than for control group. Increase in Oxygen saturation was statistically significant at 4 week with small effect size and increase in body weight was statistically significant with small effect sizes for intervention group than for control group. No case of hypercalcemia was reported. ConclusionOur findings suggest a potential role of adjunctive Vitamin D3 to accelerate resolution of inflammatory responses and improvement in clinical outcomes of pulmonary TB patients. Trial registrationThis trial is registered with Clinical Trials Registry - INDIA (http://ctri.nic.in) with CTRI Number - CTRI/2021/11/037914. Place of studyRoom Number 27, first floor out-patients department (OPD) and inpatient Wards, fourth floor, Department of Respiratory Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), INDIA.

Cross sectional study on the relationship between serum calcium level and severity of dengue fever

Background: Dengue is the most rapidly spreading mosquito borne disease in the world. An estimated 50 million dengue infections occur annually. It is caused by a small, single stranded RNA virus belonging to the genus Flavivirus, family Flaviviridae and is divided into four serotypes (DEN-1 to DEN-4). These various serotypes are transmitted to humans through the bites of infected Aedes mosquitoes, primarily Aedes aegypti. Materials &amp; Methods: A cross sectional study was conducted on 72 patients with dengue fever, for a period of 12 months in the medicine wards of Government Medical College, Kottayam. All cases fulfilling the inclusion criteria during the study period were included after SRC and IRB approval. Results: Mean age of patients in the present study was 32.6 in dengue fever and 32.1 in severe dengue. There was no significant correlation between age and serum corrected calcium level (Pearson correlation coefficient – 0.074, p value 0.539). In patients with dengue fever, mean hematocrit was 39.2 %, while in those with severe dengue, it was 40.5 %. There was no significant correlation between hematocrit and serum corrected calcium level (Pearson correlation coefficient – 0.147, p value 0.219).

Atorvastatin lowers serum calcium levels in lithium-users: results from a randomized controlled trial

BackgroundAlthough lithium is considered the gold-standard treatment for bipolar disorder (BD), it is associated with a variety of major endocrine and metabolic side effects, including parathyroid hormone (PTH) dependent hypercalcemia. Aside from surgery and medication discontinuation, there are limited treatments for hypercalcemia. This paper will assess data from a randomized controlled trial (RCT).MethodsThis is a secondary analysis of an RCT that explored the effects of atorvastatin (n = 27) versus placebo (n = 33) on lithium-induced nephrogenic diabetes insipidus (NDI) in patients with BD and major depressive disorder (MDD) using lithium (n = 60), over a 12-week period. This secondary analysis will explore serum calcium levels and thyroid stimulating hormone (TSH) measured at baseline, week 4, and week 12.ResultsAt 12-weeks follow-up while adjusting results for baseline, linear regression analyses found that corrected serum calcium levels were significantly lower in the treatment group (mean (M) = 2.30 mmol/L, standard deviation (SD) = 0.07) compared to the placebo group (M = 2.33 mmol/L, SD = 0.07) (β = − 0.03 (95% C.I.; − 0.0662, − 0.0035), p = 0.03) for lithium users. There were no significant changes in TSH.ConclusionIn lithium users with relatively normal calcium levels, receiving atorvastatin was associated with a decrease in serum calcium levels. Although exciting, this is a preliminary finding that needs further investigation with hypercalcemic patients. Future RCTs could examine whether atorvastatin can treat PTH dependent hypercalcemia due to lithium and other causes.

Short Term Hospital Outcome of Intracerebral Hemorrhage on The Basis of Admission Serum Calcium Level

(1) Background: Spontaneous intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes and is a leading cause of disability, with a one-month mortality rate of 40%. Whereas factors predicting short-term mortality are well known, data regarding long-term outcome are scarce and imprecise. Only a few studies revealed association of serum calcium level with outcome of stroke particularly ischaemic stroke but data regarding intracerebral hemorrhage is very limited. Therefore, to reveal the short-term hospital outcome of intracerebral hemorrhage patient on the basis of admission serum calcium level is the objective of the study. Methods: This study was a hospital based observational study and conducted at the Department of Neurology, Neurosurgery and Medicine in Dhaka Medical College Hospital. People who were suffering from intracerebral haemorrhage and were admitted in the department of Neurology, Neurosurgery and Medicine were approached for inclusion in the study according to inclusion and exclusion criteria. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Diagnosis was confirmed by researcher with the aid of CT scan. Total 365 consecutive samples were collected and incompletion of data was considered exclusion of the study. Following radiological confirmation blood were drawn to measure serum calcium level with maintaining all aseptic precautions. For analysis patients’ corrected serum calcium level were divided into three tertiles: T1 = &lt;2.20 mmol/l, T2 = 2.20 to 2.40 mmol/l and T3 = &gt;2.40 mmol/l. The principal investigator interviewed each patient individually and in case of unconscious patient; history was collected from attendant of the patient. All these were registered, documented and analyzed in the statistical program Statistical Package for Social Science (SPSS) version 20.0. Results: Out of a total of 365 patients, Mean age of the population was 58.43(±12.33).................

Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

ObjectiveSecondary hyperparathyroidism commonly occurs in the setting of mid-to low-normal serum calcium levels, often in the setting of chronic kidney disease, phosphate loading, vitamin D deficiency, or insufficient calcium intake or absorption. In this article, we report 9 patients who had adequate kidney function (estimated glomerular filtration rate >60 mL/min/1.73 m2) and normal 25-hydroxy vitamin D level (≥30 ng/dL) and whose secondary hyperparathyroidism resolved after starting adequate oral calcium intake. MethodsOur retrospective case series included 8 women and 1 man; the mean age was 69.0 ± 12.2 years (mean ± standard deviation). The initial intact parathyroid hormone (iPTH) level was 80.6 ± 13.4 pg/mL (reference range [ref], 10-65 pg/mL), corrected serum calcium level was 9.2 ± 0.2 mg/dL (ref, 8.5-10.5 mg/dL), serum phosphate level was 3.6 ± 0.4 mg/dL (ref, 2.5-4.9 mg/dL), 25-hydroxy vitamin D level was 42.2 ± 10.5 mg/dL (ref, 20-50 ng/mL), and estimated glomerular filtration rate was 72.6 ± 14.4 mL/min/1.73 m2. Patients were treated clinically with oral calcium 600 mg twice a day. ResultsiPTH was retested after a mean duration of 17.6 ± 12.7 days of calcium supplementation; the iPTH level decreased to 51.0 ± 10.6 pg/mL, with all patients achieving iPTH in the normal range with normocalcemia, consistent with hyperparathyroidism being because of insufficient calcium intake or absorption. All patients were normocalcemic after supplementation. ConclusionSecondary hyperparathyroidism can result from insufficient oral calcium intake. Calcium challenge is an efficacious and cost-effective tool for confirming and treating secondary hyperparathyroidism in the setting of normal vitamin D levels and kidney function.

FREQUENCY OF HYPOCALCAEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Background: Chronic kidney disease is a major public health problem worldwide. Kidney failure is becoming increasingly common and is associated with poor health outcomes and high medical expenditures. Objective: To determine the frequency of hypocalcemia among patients with chronic kidney disease. Setting: Department of General Medicine, Hayatabad Medical Complex, Peshawar. Duration of study: Six months 6/5/2019 to 6/11/2019. Study design: Cross sectional study. Materials and Methods: Total 194 patients were included in the study. Detail history, clinical examination and laboratory investigation was preformed for the confirmation of CKD. From all the patients at admission, 3cc of blood was obtained under strict aseptic technique and was immediately sent to hospital laboratory to detect hypocalcaemia and hypocalcaemia was considered positive if the serum corrected calcium level &lt;8.5mg/dL. Results: Stages of CKD was analyzed as 17(9%) patients had CKD stage 1, 29(15%) patients had stage 2, 54(28%) had stage 3, 51(26%) had stage 4, 43(22%) had stage 5 respectively. More over 50(26%) patients had hypocalcemia while 144(74%) patients didnt. Seventy four 74(38%) patients had duration of CKD ≤ 6 months while 120(62%) patients had duration of CKD &gt;6 month. Mean duration of CKD was 7 months with standard deviation ± 3.78. One hundred and forty 140 (72%) patients had weight ≤80 Kgs while 54(28%) patients weight &gt;80 Kgs. Mean weight was 76 Kgs with standard deviation ± 15.29. Conclusion: Frequency of hypocalcemia was found about 26% in patients with chronic kidney disease.

Fibroblast Growth Factor-23 in Pre-Dialysis Chronic Kidney Disease Patients and its Correlation with Carotid Artery Calcification.

Fibroblast growth factor 23 (FGF-23) is a phosphate metabolism regulator in patients with chronic kidney disease (CKD). The present study is aimed to examine the FGF-23 level in pre-dialysis patients with CKD and its correlation with carotid artery calcification (CAAC). This cross-sectional study included patients with CKD and controls. The patients were compared with controls having similar distribution of age and sex to determine serum FGF-23 level in Indian healthy adult population. Detailed medical history, physical examination, and investigations were done for each patient. Atherosclerotic risk factors, cardiovascular comorbidities, and drug history were recorded. Carotid calcification was observed using carotid ultrasound. In total, 62 patients with a mean age of 50.0 years were enrolled. Majority of the patients had hypertension (66.1%), followed by diabetes (27.4%) and dyslipidemia (3.2%). Mean serum corrected calcium levels were significantly higher in patients with CAAC compared to the patients without CAAC (9.21 ± 1.34 vs. 8.53 ± 0.93 mg/dL; P = 0.014). The FGF-23 levels were significantly higher in patients with CAAC compared to those without CAAC (396.0 vs. 254.0 pg/mL; P = 0.008). CAAC was found to be present in both early and late stages of CKD. Multivariate analysis showed that log FGF-23 and serum corrected calcium remained as independent determinants of CAAC. The prevalence of CAAC increased with the ascending quartiles of FGF23. In conclusion, FGF-23 was found to be independently associated with CAAC in CKD.

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

BackgroundTo investigate whether hypocalcemia influenced total blood loss and transfusion rate in elderly patients with hip fracture.MethodsFrom our hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium level was corrected for albumin concentration, and hypocalcaemia was defined as corrected calcium < 2.11 mmol/L. Hemoglobin and hematocrit were obtained on admission day and postoperative day, and blood transfusions were collected. According to the combination formulas of Nadler and Gross, the total blood loss of each patient was calculated. Risk factors were further analyzed by multivariate linear regression.ResultsA total of 583 consecutive elderly hip fracture patients were finally included (mean age 79.32 ± 8.18 years, 68.61% female). On admission, the mean serum corrected calcium level was 2.17 ± 0.14 mmol/L, and the prevalence of hypocalcemia was 33.11% (95% CI: 29.42–37.02). When comparing patients with normal calcium, hypocalcemia patients exhibited a higher blood transfusion rate (7.69% vs 16.06%, P < 0.05), and significantly larger total blood loss (607.86 ± 497.07 ml vs 719.18 ± 569.98 ml, P < 0.05). Multivariate linear regression analysis showed that male, anemia on admission, time from injury to hospital, intertrochanteric fracture, blood transfusion and hypocalcemia were independently associated with increased total blood loss (P < 0.05).ConclusionHypocalcemia is common in elderly patients with hip fracture, and significantly associated with more total blood loss and blood transfusion. The other risk factors for increased total blood loss are male, anemia on admission, time from injury to hospital, intertrochanteric fracture, and blood transfusion.Level of evidenceLevel III, retrospective study.