Total Calcium and Ionized Calcium (pH = 7.4) Tests Are Equal When Screening Patients for Hypercalcemia at Admission in the Emergency Department: A Retrospective Descriptive Study

Regitze Wittenberg, Trine Rennebod Larsen, Lis Stilgren, Steen Antonsen

Abstract


Background: Ionized calcium (pH = 7.4) (CaI) is a laborious test compared to tests for total calcium (CaT). However, CaI is the biologically active part of calcium in the blood and is therefore often considered the most relevant measure of calcium status. In this study, CaI and CaT tests were compared by identifying clinically relevant hypercalcemia (HC) in unselected patients acutely admitted to an emergency department (ED).

Methods: CaI and CaT were measured in all medical patients admitted to the ED at a single Danish Hospital (N = 13,400) between January 2018 and May 2019. The majority (97%) of the patients were admitted 1 - 3 times summing up to a total of 17,838 admissions. As limits for clinically relevant HC, 1.45 mmol/L for CaI and 2.77 mmol/L for CaT were used. Mismatches were defined as one test being equal to or above the limit while the other test was within or below its reference interval. In cases of mismatch, the medical record was reviewed.

Results: Seventeen mismatches with CaI ? 1.45 mmol/L were observed in 16 patients, of whom eight were known with diseases with risk of HC. Five patients had HC with no clinical relevance, one had HC of unknown relevance, and only two patients were discovered as having a prior unknown calcium metabolic disease. Three mismatches were observed in admissions with CaT ? 2.77 mmol/L. Mismatches did in none of these cases have any clinical consequences.

Conclusion: By using CaT as a screening method for HC instead of CaI, only two patients with prior unrecognized HC would have been missed and it did not result in a large number of patients with false HC. We therefore find that CaT is an acceptable test when screening for HC in the ED.




J Endocrinol Metab. 2021;11(5):108-114
doi: https://doi.org/10.14740/jem757

Keywords


Ionized calcium; Total calcium; Hypercalcemia

Full Text: HTML PDF Suppl1 Suppl2
 

Browse  Journals  

 

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

 

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

 

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

 

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

 

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 
       
 

Journal of Endocrinology and Metabolism, bimonthly, ISSN 1923-2861 (print), 1923-287X (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.jofem.org   editorial contact: editor@jofem.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.