Background: Hypercalcaemia is a common finding in in-patients. Acute hypercalcaemia can be life-threatening; thus proper work-up is pivotal for correct assessment of underlying-cause and management. The European Hypercalcaemia Guidelines 2016 was used as reference.
Aim: Study was undertaken to assess appropriateness in work-up, diagnosis and management of patients with hypercalcaemia according to European Guidelines.
Methods: Patients diagnosed with hypercalcaemia between November 2017 and December 2018 admitted to a DGH across medical and surgical specialities were included in this retrospective study. Data was obtained from medical records for symptoms of hypercalcaemia and biochemical tests (including adjusted-serum-calcium; adj.S.Ca), and patients detailed management plans.
Results: 50 patients were included in the study, (17 males; mean age: 76.1 years. Hypercalcaemia was mild in majority of patients (n=43; 84%) (adj.S.Ca ≥2.67 <3.0 mmol/l); than moderate (adj.S.Ca ≥3 <3.5 mmol/l) (n=5;10%) and severe (n=3; 6%) (adj.S.Ca ≥3.5 mmol/l.) 31 patients (62%) demonstrated symptoms of hypercalcaemia. All patients had renal function tests assessed on admission, 98% had phosphate levels measured, but parathyroid hormone (PTH) measured in only in 19(38%) patients and Vitamin D in 32%. ECG was done in 24% and 1 patient had ECG changes. Of the patients who had PTH measured 52% had high PTH-levels, 31% had low, and 15% had normal PTH levels. Of those with high/normal PTH, 76% were referred to an Endocrinologist. 16% had known malignancy. 6% of patients with low PTH had malignancy. Management varied within the group: 14% received intravenous fluids, bisphosphonates 8%, Steroids 8%, Dialysis 2%. 74% had repeat adj.S.calcium after 24 h. No patient had 24 h urine-calcium. Management of hypercalcaemia was appropriate in 60% patients. Only 12% had follow-up with Endocrinology.
Conclusion: Guidelines are poorly followed in in-patients for assessment and management of hypercalcaemia. Training of health care professionals is crucial for delivery of best care to such patients.