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Is severe hypercalcemia immediately life-threatening?

Guimard, Camillea; Batard, Erica; Lavainne, Frédéricb; Trewick, Davida

European Journal of Emergency Medicine: April 2018 - Volume 25 - Issue 2 - p 110–113
doi: 10.1097/MEJ.0000000000000462

Objective Severe hypercalcemia is often considered an emergency because of a potential risk of cardiac arrest or coma. However, there is little evidence to support this. The aim of our study was to assess whether severe hypercalcemia (Ca>4 mmol/l or 16 mg/dl) was associated with immediately life-threatening cardiac arrhythmias or neurological complications in patients admitted to the Emergency Department (ED).

Methods A retrospective observational study was carried out over a 5-year period (2008–2012). Eligible patients were admitted to the Adult Emergency Department of Nantes University Hospital and had a calcium concentration in excess of 4 mmol/l. There were no exclusion criteria. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED. The secondary outcomes were correlation between calcium concentrations/ECG QTc intervals and mortality.

Results A total of 126 204 adult patients had calcium concentrations measured. Thirty one (0.025%) patients had severe hypercalcemia as defined in our study. The median calcium concentration was 4.3 mmol/l (Q1, 4.2; Q3, 4.7) and the median albumin-adjusted calcium concentration was 4.3 mmol/l (Q1, 4.1; Q3, 4.7). No patient presented with a life-threatening cardiac event during stay in the ED. The median ED stay was 7 h 32 min. One patient presented with a coma of multifactorial origin. There was no correlation between calcemia and QTc intervals (P=0.60). Mortality at 1 year was 55% (17 patients).

Conclusion We found no cases of immediately life-threatening cardiac arrhythmias or neurological complications associated with hypercalcemia above 4 mmol/l over a 5-year period in a large tertiary ED.

Departments of aEmergency Medicine

bNephrology, Nantes University Hospital, Nantes Cedex 01, France

Correspondence to David Trewick, MD, Department of Emergency Medicine, Nantes University Hospital, 44000 Nantes Cedex 01, France Tel: +33 240 084 435; fax: +33 240 087 875;e-mail:

Received May 24, 2016

Accepted March 6, 2017

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