Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
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Original Article

Volume 11, Number 5, October 2021, pages 108-114

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


Figure 1.
Figure 1. Distribution of CaI and CaT in 17,838 admissions. Unbroken lines represent reference limits for CaT and CaI. Dotted lines represent the limits for hypercalcemia. CaT: total calcium; CaI: ionized calcium (pH = 7.4).


Table 1. Admissions According to Levels of CaT and CaI in mmol/L
< 2.152.15 - 2.512.52 - 2.76≥ 2.77Total
aMismatches. bDiscrepancies. CaT: total calcium; CaI: ionized calcium (pH = 7.4).
  ≥ 1.450a17a9982198
  1.33 - 1.441b1,490b523152,029
  1.18 - 1.3275112,935239b3a13,928
  < 1.188328501b0a1,683


Table 2. Mismatches
Patient no.GenderAge (years)CaT (mmol/L)CaI (mmol/L)Albumin (g/L)Creatinine (µmol/L)/eGFR (mL/min/1.73 m2)Course for admissionPrior relevant comorbidityReason for hypercalcemiaClinical relevance
aResults outside reference limits. CaT: total calcium; CaI: ionized calcium (pH = 7.4); eGFR: estimated glomerular filtration rate; PHPT: primary hyperparathyroidism; COPD: chronic obstructive pulmonary disease; FHH: familial hypocalciuric hypercalcemia; GEJ: gastroesophageal junction; CKD: chronic kidney disease; NET: neuroendocrine tumor.
1F90.92.411.50a26a61/77Urine retentionPHPTPHPTNo
2M50.72.481.46a4181/> 90Abdominal painOne kidneyPHPTYes
3M92.72.461.48a32a64/81Thorax painNonePHPTYes
4F70.72.471.46a25a53/> 90PneumoniaDisseminated breast cancer (bone metastasis)Malignancy/bone metastasisNo
6F57.52.511.48a4058/> 90Chest pain/paresthesia in handsNoneUnknownNo
7F93.22.361.52a25a117/35aImpaired general condition, fallMultiple myeloma, terminalMultiple myeloma, CKDNo
8F74.62.51.50a3454/90COPDFHH, osteoporosisFHHNo
9F53.62.51.45a4047/> 90Impaired general conditionDisseminated GEJ cancer (no known bone metastasis)Malignancy/bone metastasisNo
12F81.82.461.49a22a48/88Impaired general condition, pneumoniaOsteoporosisUnknownNo
13F57.42.441.46a28a225/20aErysipelasCKD, thyrotoxicosisCKDNo
14F902.511.52a27a78/59Impaired general condition, erysipelasNoneCalcium supplement + dehydrationNo
15F79.82.431.45a26a36/> 90Urine tract infectionNoneCalcium supplement + dehydrationNo
16F53.92.441.45a4154/> 90Abdominal pain, operation showed NETNoneUnknownUncertain
18M68.22.9a1.2744103/64Perforated ulcerHypercalcemia, unknown reasonCalcium metabolic disease?No
19M66.22.78a1.2747935/5aInguinal painTerminal CKD, dialysisCKDNo