Hypocalcemia in critically ill patients
Hypocalcemia is an important metabolic problem in critical care medicine. To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81...
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| Veröffentlicht in: | Critical care medicine 1982-12, Vol.10 (12), p.848-851 |
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| container_title | Critical care medicine |
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| creator | CHERNOW, BART ZALOGA, GARY McFADDEN, ELLEN CLAPPER, MARK KOTLER, MITCHELL BARTON, MATTHEW RAINEY, THOMAS G |
| description | Hypocalcemia is an important metabolic problem in critical care medicine. To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81%) had a serum calcium (Ca) measured. Of these 210 patients, 135 (64%) were hypocalcemic (serum Ca < 8.5 mg/dl) and 75 (36%) were normocalcemic. Serum albumin concentration was |
| doi_str_mv | 10.1097/00003246-198212000-00008 |
| format | Article |
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To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81%) had a serum calcium (Ca) measured. Of these 210 patients, 135 (64%) were hypocalcemic (serum Ca < 8.5 mg/dl) and 75 (36%) were normocalcemic. Serum albumin concentration was <3.5 g/dl in 70% of the hypocalcemic patients who had albumin measured, suggesting that the ionized Ca concentration may have been normal in many of these patients. On the other hand, 32% of the hypocalcemic patients were alkalotic (pH ≥7.45) which indicates that ionized Ca levels may have been low because Ca binding to protein increases with alkalosis. Gastrointestinal bleeders and postabdominal surgery patients were more likely to have low total serum Ca whereas cardiac and neurosurgical patients were more likely to have a normal total serum Ca (p < 0.05). Ionized Ca was calculated in 36 of the normocalcemic and 80 of the hypocalcemic patients. The hypocalcemic group had significantly lower ionized Ca levels when compared to those of the normocalcemic group (p < 0.001). Patients with low serum Ca values spent a longer time in the ICU (p < 0.01), had an increased incidence of renal failure and sepsis (p < 0.01), had an increased mortality rate (p < 0.002), and received a greater number of blood transfusions (p < 0.001) than patients in the normocalcemic group. It is concluded that(1) hypocalcemia is a frequent finding in critically ill patients; (2) determining ionized Ca levels is useful because many ICU patients have alterations in both arterial pH and serum albumin levels; (3) hypoalbuminemia, sepsis, red cell transfusions, and renal failure are predisposing factors for hypocalcemia; and (4) hypocalcemic patients do less well clinically than normocalcemic patients.]]></description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-198212000-00008</identifier><identifier>PMID: 7140332</identifier><language>eng</language><publisher>United States: Williams & Wilkins</publisher><subject>Calcium - blood ; Humans ; Hydrogen-Ion Concentration ; Hypocalcemia - epidemiology ; Hypocalcemia - therapy ; Intensive Care Units ; Maryland ; Retrospective Studies ; Serum Albumin - analysis</subject><ispartof>Critical care medicine, 1982-12, Vol.10 (12), p.848-851</ispartof><rights>Williams & Wilkins 1982. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3558-f333124aecdebf82eed0d9b5ea4fb6f0dc254bbcd3e66212cc04399b08d8076e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7140332$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CHERNOW, BART</creatorcontrib><creatorcontrib>ZALOGA, GARY</creatorcontrib><creatorcontrib>McFADDEN, ELLEN</creatorcontrib><creatorcontrib>CLAPPER, MARK</creatorcontrib><creatorcontrib>KOTLER, MITCHELL</creatorcontrib><creatorcontrib>BARTON, MATTHEW</creatorcontrib><creatorcontrib>RAINEY, THOMAS G</creatorcontrib><title>Hypocalcemia in critically ill patients</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description><![CDATA[Hypocalcemia is an important metabolic problem in critical care medicine. To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81%) had a serum calcium (Ca) measured. Of these 210 patients, 135 (64%) were hypocalcemic (serum Ca < 8.5 mg/dl) and 75 (36%) were normocalcemic. Serum albumin concentration was <3.5 g/dl in 70% of the hypocalcemic patients who had albumin measured, suggesting that the ionized Ca concentration may have been normal in many of these patients. On the other hand, 32% of the hypocalcemic patients were alkalotic (pH ≥7.45) which indicates that ionized Ca levels may have been low because Ca binding to protein increases with alkalosis. Gastrointestinal bleeders and postabdominal surgery patients were more likely to have low total serum Ca whereas cardiac and neurosurgical patients were more likely to have a normal total serum Ca (p < 0.05). Ionized Ca was calculated in 36 of the normocalcemic and 80 of the hypocalcemic patients. The hypocalcemic group had significantly lower ionized Ca levels when compared to those of the normocalcemic group (p < 0.001). Patients with low serum Ca values spent a longer time in the ICU (p < 0.01), had an increased incidence of renal failure and sepsis (p < 0.01), had an increased mortality rate (p < 0.002), and received a greater number of blood transfusions (p < 0.001) than patients in the normocalcemic group. It is concluded that(1) hypocalcemia is a frequent finding in critically ill patients; (2) determining ionized Ca levels is useful because many ICU patients have alterations in both arterial pH and serum albumin levels; (3) hypoalbuminemia, sepsis, red cell transfusions, and renal failure are predisposing factors for hypocalcemia; and (4) hypocalcemic patients do less well clinically than normocalcemic patients.]]></description><subject>Calcium - blood</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Hypocalcemia - epidemiology</subject><subject>Hypocalcemia - therapy</subject><subject>Intensive Care Units</subject><subject>Maryland</subject><subject>Retrospective Studies</subject><subject>Serum Albumin - analysis</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1982</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAQhi0EKqXwE5AywRSwfU5ijwgBRarEArPlOBfV4DTFTlT13-PS0o1bTve-96WHkIzRO0ZVdU9TABdlzpTkjKcq30nyhExZAangCk7JlFJFcxAKzslFjJ-UMlFUMCGTigkKwKfkdr5d99Z4i50zmVtlNrjBJcFvM-d9tjaDw9UQL8lZa3zEq0OekY_np_fHeb54e3l9fFjkFopC5i0AMC4M2gbrVnLEhjaqLtCIti5b2lheiLq2DWBZpsetpQKUqqlsJK1KhBm52e9dh_57xDjozkWL3psV9mPUlQCpBCtTo9w32tDHGLDV6-A6E7aaUb1jpP8Y6SOjX0mm0evDjbHusDkOHqAkX-z9Te8HDPHLjxsMeonGD0v9H3r4AZOLcJs</recordid><startdate>198212</startdate><enddate>198212</enddate><creator>CHERNOW, BART</creator><creator>ZALOGA, GARY</creator><creator>McFADDEN, ELLEN</creator><creator>CLAPPER, MARK</creator><creator>KOTLER, MITCHELL</creator><creator>BARTON, MATTHEW</creator><creator>RAINEY, THOMAS G</creator><general>Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>198212</creationdate><title>Hypocalcemia in critically ill patients</title><author>CHERNOW, BART ; ZALOGA, GARY ; McFADDEN, ELLEN ; CLAPPER, MARK ; KOTLER, MITCHELL ; BARTON, MATTHEW ; RAINEY, THOMAS G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3558-f333124aecdebf82eed0d9b5ea4fb6f0dc254bbcd3e66212cc04399b08d8076e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1982</creationdate><topic>Calcium - blood</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Hypocalcemia - epidemiology</topic><topic>Hypocalcemia - therapy</topic><topic>Intensive Care Units</topic><topic>Maryland</topic><topic>Retrospective Studies</topic><topic>Serum Albumin - analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CHERNOW, BART</creatorcontrib><creatorcontrib>ZALOGA, GARY</creatorcontrib><creatorcontrib>McFADDEN, ELLEN</creatorcontrib><creatorcontrib>CLAPPER, MARK</creatorcontrib><creatorcontrib>KOTLER, MITCHELL</creatorcontrib><creatorcontrib>BARTON, MATTHEW</creatorcontrib><creatorcontrib>RAINEY, THOMAS G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CHERNOW, BART</au><au>ZALOGA, GARY</au><au>McFADDEN, ELLEN</au><au>CLAPPER, MARK</au><au>KOTLER, MITCHELL</au><au>BARTON, MATTHEW</au><au>RAINEY, THOMAS G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypocalcemia in critically ill patients</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>1982-12</date><risdate>1982</risdate><volume>10</volume><issue>12</issue><spage>848</spage><epage>851</epage><pages>848-851</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><abstract><![CDATA[Hypocalcemia is an important metabolic problem in critical care medicine. To determine the frequency of this problem and the patient subsets at risk, a retrospective study of a large series of ICU patients was performed. During the study period, 259 patients were admitted to the ICU, of whom 210 (81%) had a serum calcium (Ca) measured. Of these 210 patients, 135 (64%) were hypocalcemic (serum Ca < 8.5 mg/dl) and 75 (36%) were normocalcemic. Serum albumin concentration was <3.5 g/dl in 70% of the hypocalcemic patients who had albumin measured, suggesting that the ionized Ca concentration may have been normal in many of these patients. On the other hand, 32% of the hypocalcemic patients were alkalotic (pH ≥7.45) which indicates that ionized Ca levels may have been low because Ca binding to protein increases with alkalosis. Gastrointestinal bleeders and postabdominal surgery patients were more likely to have low total serum Ca whereas cardiac and neurosurgical patients were more likely to have a normal total serum Ca (p < 0.05). Ionized Ca was calculated in 36 of the normocalcemic and 80 of the hypocalcemic patients. The hypocalcemic group had significantly lower ionized Ca levels when compared to those of the normocalcemic group (p < 0.001). Patients with low serum Ca values spent a longer time in the ICU (p < 0.01), had an increased incidence of renal failure and sepsis (p < 0.01), had an increased mortality rate (p < 0.002), and received a greater number of blood transfusions (p < 0.001) than patients in the normocalcemic group. It is concluded that(1) hypocalcemia is a frequent finding in critically ill patients; (2) determining ionized Ca levels is useful because many ICU patients have alterations in both arterial pH and serum albumin levels; (3) hypoalbuminemia, sepsis, red cell transfusions, and renal failure are predisposing factors for hypocalcemia; and (4) hypocalcemic patients do less well clinically than normocalcemic patients.]]></abstract><cop>United States</cop><pub>Williams & Wilkins</pub><pmid>7140332</pmid><doi>10.1097/00003246-198212000-00008</doi><tpages>4</tpages></addata></record> |
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| language | eng |
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| source | MEDLINE; Journals@Ovid Ovid Autoload |
| subjects | Calcium - blood Humans Hydrogen-Ion Concentration Hypocalcemia - epidemiology Hypocalcemia - therapy Intensive Care Units Maryland Retrospective Studies Serum Albumin - analysis |
| title | Hypocalcemia in critically ill patients |
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