Clinical evaluation of total serum calcium in primary hyperparathyroidism and the risk of death after surgery

Abstract This paper presents the final results obtained by this laboratory during a 3½-year investigation of primary hyperparathyroidism. The project involved establishment of a routine test procedure for more reliable diagnosis of this condition; a study of the incidence of renal lithiasis in hyperparathyroidism, and, finally, the subject of the present paper-the obtaining of data to construct a nomogram for estimation of diffusible serum calcium from the total serum calcium and the albumin and globulin levels.

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INCREASED SERUM CALCIUM IS NOT COMMON IN HOSPITALIZED PATIENTS WITH PRIMARY HYPERPARATHYROIDISM: A RETROSPECTIVE, OBSERVATIONAL STUDY

Endocrine Practice ◽

10.4158/ep-2019-0349 ◽

2020 ◽

Vol 26 (3) ◽

pp. 285-290

Author(s):

Muhammad Abu Tailakh ◽

Ahmad Yahia ◽

Ilia Polischuck ◽

Yair Liel

Keyword(s):

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Medical Records ◽

Reference Range ◽

Laboratory Data ◽

Hospitalized Patients ◽

Total Serum ◽

Normal Reference Range ◽

Total Serum Calcium ◽

The Mean

Objective: Serum calcium levels often decrease during acute illness in patients with an intact calcium-regulating system. However, the dynamics of serum calcium levels in hospitalized patients with primary hyperparathyroidism (PHPT) have not yet been described. Methods: Clinical and laboratory data were retrospectively retrieved from the electronic medical records of patients with PHPT before, during, and after hospitalization for various reasons (excluding parathyroid surgery). Results: There were 99 nonselected patients with asymptomatic, hypercalcemic PHPT, hospitalized for various reasons; 42% were admitted for apparent infectious or septic conditions, and 58% were admitted for noninfectious conditions. Total serum calcium increased >0.5 mg/dL in 7.4% of the patients: 10.9% and 2.5% of the patients with noninfectious and infectious conditions, respectively. In 65.7% of the patients, the mean total serum calcium (TsCa), but not albumin-corrected calcium (corrCa), decreased significantly during hospitalization, down to below the upper limit of the reference range. Although prehospitalization TsCa and corrCa were similar in patients with infectious and noninfectious conditions, during hospitalization, TsCa was lower in patients with infectious conditions ( P = .02). Both TsCa and albumin returned to prehospitalization levels after recovery. Conclusion: TsCa increases in a minority of hospitalized PHPT patients. In the majority of hospitalized patients with PHPT, TsCa, but not corrCa, decreases to within the normal reference range, more so in patients with infectious conditions, obscuring the major characteristic of PHPT. Therefore, it is prudent to follow calcium and corrCa during hospitalization in patients with PHPT. Abbreviations: corrCa = albumin-corrected serum calcium; IQR = interquartile range; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TsCa = total serum calcium

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Intraoperative monitoring of kinetic total serum calcium levels in primary hyperparathyroidism operation

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2004.08.016 ◽

2004 ◽

Vol 199 (6) ◽

pp. 1000-1001

Author(s):

Farah Arshad ◽

Anand K. Mishra ◽

A.K. Verma ◽

Gaurav Agarwal ◽

Amit Agarwal ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Intraoperative Monitoring ◽

Total Serum ◽

Total Serum Calcium

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Cinacalcet normalizes serum calcium in a double-blind randomized, placebo-controlled study in patients with primary hyperparathyroidism with contraindications to surgery

Acta Endocrinologica ◽

10.1530/eje-14-0877 ◽

2015 ◽

Vol 172 (5) ◽

pp. 527-535 ◽

Cited By ~ 27

Author(s):

Aliya Khan ◽

John Bilezikian ◽

Henry Bone ◽

Andrey Gurevich ◽

Peter Lakatos ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Controlled Study ◽

Total Serum ◽

Open Label ◽

Double Blind ◽

Serum Calcium Concentration ◽

Total Serum Calcium ◽

Normal Mean ◽

Serum Pth

ObjectivePrimary hyperparathyroidism (PHPT) is diagnosed by the presence of hypercalcemia and elevated or nonsuppressed parathyroid hormone (PTH) levels. Although surgery is usually curative, some individuals fail or are unable or unwilling to undergo parathyroidectomy. In such individuals, targeted medical therapy may be of value. Cinacalcet normalized calcium level and lowered PTH in patients with PHPT in several phase 2 and open-label studies. We compared cinacalcet and placebo in subjects with PHPT unable to undergo parathyroidectomy.DesignPhase 3, double-blind, multi centere, randomized, placebo-controlled study.MethodsSixty-seven subjects (78% women) with moderate PHPT were randomized (1:1) to cinacalcet or placebo for ≤28 weeks.Main outcome measureAchievement of a normal mean corrected total serum calcium concentration of ≤10.3 mg/dl (2.575 mmol/l).ResultsBaseline median (quartile 1 (Q1), Q3) serum PTH was 164.0 (131.0, 211.0) pg/ml and mean (s.d.) serum Ca was 11.77 (0.46) mg/dl. Serum Ca normalized (≤10.3 mg/dl) in 75.8% of cinacalcet- vs 0% of placebo-treated subjects (P<0.001). Corrected serum Ca decreased by ≥1.0 mg/dl from baseline in 84.8% of cinacalcet- vs 5.9% of placebo-treated subjects (P<0.001). Least squares mean (s.e.m.) plasma PTH change from baseline was −23.80% (4.18%) (cinacalcet) vs −1.01% (4.05%) (placebo) (P<0.001). Similar numbers of subjects in the cinacalcet and placebo groups reported adverse events (AEs) (27 vs 20) and serious AEs (three vs four). Most commonly reported AEs were nausea and muscle spasms.ConclusionsThese results demonstrate that cinacalcet normalizes serum calcium in this PHPT population and appears to be well tolerated.

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The Reference Intervals Used in Pediatric Medical Analysis Laboratories to Interpret the Results Analysis for Total Serum Calcium

Revista de Chimie ◽

10.37358/rc.17.2.5428 ◽

2017 ◽

Vol 68 (2) ◽

pp. 243-245

Author(s):

Elisabeta Antonescu ◽

Maria Totan ◽

Gheorghe Cornel Boitor ◽

Julianna Szakacs ◽

Sinziana Calina Silisteanu ◽

...

Keyword(s):

Serum Calcium ◽

Colorimetric Method ◽

Age Groups ◽

Essential Element ◽

Reference Intervals ◽

Total Serum ◽

Electronic Archive ◽

Total Serum Calcium ◽

Analysis Laboratory ◽

Medical Analysis

Medical analysis laboratory must establish its own reference intervals depending on the facilities they are working with, the working substances and protocols. These reference intervals must be obtained depending on age groups in order to accurately interpret the results of the analyzes performed. The study is a retrospective one using 3217 data from the electronic archive of the S.C. Vladutiu&Garabedian S.R.L. Clinic in Medias. Total serum calcium was determined by the colorimetric method on the Konelab analyzer. Processing of the collected data was done using the Hoffmann method, considering 5% up to 95% of the values in the database, the values being randomly selected. For comparison, data from the literature was used. In children under 1 year old, it was not possible to calculate the reference intervals since data was insufficient. In the other age groups, reference intervals obtained in the current study were similar to the studied literature. Reference intervals established for calcium can provide important guidance for the reasonable supplementation of this essential element in children.

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Studies on Ionized Calcium in Serum and Plasma from Normal Cows. Its Relation to Total Serum Calcium and the Effects of Sample Storing

Acta Veterinaria Scandinavica ◽

10.1186/bf03547588 ◽

1978 ◽

Vol 19 (4) ◽

pp. 487-496

Author(s):

Clarence Kυart ◽

Lasse Larsson

Keyword(s):

Serum Calcium ◽

Ionized Calcium ◽

Total Serum ◽

Total Serum Calcium

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Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04005-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rahel D. Gebreyohannes ◽

Ahmed Abdella ◽

Wondimu Ayele ◽

Ahizechukwu C. Eke

Keyword(s):

Serum Calcium ◽

Calcium Intake ◽

Calcium Level ◽

Serum Calcium Level ◽

Dietary Calcium ◽

Ionized Calcium ◽

Dietary Calcium Intake ◽

Total Serum ◽

Total Serum Calcium ◽

Total Serum Calcium Level

Abstract Background Preeclampsia is a well-known cause of maternal mortality and morbidity in Ethiopia. The exact pathophysiology has not been fully understood. Calcium and magnesium deficiencies have been given emphasis to play roles in the pathophysiology. Although evidence is abundant, they are equivocal. The study aimed to see the association of dietary calcium intake, serum total calcium level and ionized calcium level with preeclampsia. It also evaluated the association between dietary calcium intake and serum calcium levels. Materials and methods An unmatched case–control study was conducted in Gandhi Memorial, Tikur Anbessa, and Zewditu Memorial Hospitals, all in Addis Ababa, between October to December, 2019. Cases were 42 women with preeclampsia and controls were 42 normotensive women. The medical and obstetric history was gathered using a structured questionnaire and the dietary calcium intake information using a 24-h dietary recall. The serum levels of total serum calcium and ionized (free) calcium were measured using an inductively coupled mass spectrophotometer. Bivariate and multivariate logistic regression and Pearson correlation test were utilized during data analysis. Results In comparison with controls, women with preeclampsia had lower mean (± 1SD) levels of ionized calcium level (1.1 mmol/l ± 0.11), total serum calcium level (1.99 mmol/l ± 0.35) and lower median (IQR) dietary calcium intake (704 mg/24 h,458–1183). The odds of having preeclampsia was almost eight times greater in those participants with low serum ionized calcium level (OR 7.5, 95% CI 2.388–23.608) and three times higher in those with low total serum calcium level (OR 3.0, 95% CI 1.024–9.370). Low dietary calcium intake also showed statistically significant association with preeclampsia (OR 3.4, 95% CI 1.092 -10.723). Serum ionized calcium level and total serum calcium level showed positive correlation of moderate strength (p = 0.004, r = 0.307), but no correlation was found between dietary calcium intake with both forms of serum calcium levels. Conclusion This study showed significant association between low dietary calcium intake and low serum calcium levels with preeclampsia, hence this can be used as a supportive local evidence for the current context-specific recommendation of calcium supplementation in societies with low-dietary calcium consumption in an attempt to prevent preeclampsia, therefore implementation study should be considered in Ethiopia to look for the feasibility of routine supplementation.

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Fluoride Ingestion in Children: A Review of 87 Cases

PEDIATRICS ◽

10.1542/peds.88.5.907 ◽

1991 ◽

Vol 88 (5) ◽

pp. 907-912

Author(s):

W. Lynn Augenstein ◽

David G. Spoerke ◽

Ken W. Kulig ◽

Alan H. Hall ◽

Priscilla K. Hall ◽

...

Keyword(s):

Serum Calcium ◽

Fatal Case ◽

Gastrointestinal Symptoms ◽

Rocky Mountain ◽

Total Serum ◽

Sufficient Information ◽

Poison Center ◽

Normal Children ◽

Fluoride Treatment ◽

Total Serum Calcium

All cases of fluoride ingestion in children younger than 12 years old reported to the Rocky Mountain Poison Center between January 1 and December 31, 1986, were retrospectively reviewed. Eighty-seven cases were identified. Eighty-four cases involved accidental ingestion of dental fluoride products in the home (tablets, drops, rinses) in children 8 months to 6 years old. Two older children (8 and 9 years old) became symptomatic after fluoride treatment by a dentist. A 13-month-old child died after ingesting an unknown amount of sodium fluoride insecticide, the only insecticide exposure in our series. Postmortem total serum calcium value was 4.8 mg/dL (normal 8.8 to 10.3). No other patients had serious symptoms or sequelae. Twenty-six (30%) of 87 became symptomatic, with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) in 25 patients and drowsiness in 1. Only 3 patients became symptomatic later than 1 hour after ingestion. Analysis of data from 70 cases with sufficient information revealed that as the amount of fluoride ingested increased, the percentage of patients with symptoms increased. Not including the fatal case, 6 patients had serum calcium levels measured, and all were normal. Children who ingested up to 8.4 mg/kg of elemental fluoride in dental products had mild and self-limited symptoms, mostly gastrointestinal.

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Late Onset Hypocalcemic Seizures in Formula-Fed, Vitamin D Deficient Babies: Revisited

Journal of Neonatology ◽

10.1177/0973217920927903 ◽

2020 ◽

Vol 34 (1-2) ◽

pp. 15-18

Author(s):

Umar Amin Qureshi ◽

Abdus Sami Bhat ◽

Muzaffar Jan ◽

Uruj Qureshi

Keyword(s):

Vitamin D ◽

Breast Feeding ◽

Serum Calcium ◽

Late Onset ◽

Response To Treatment ◽

Total Serum ◽

Total Serum Calcium ◽

Vitamin D Levels ◽

Calcium Phosphorus ◽

25 Oh Vitamin D

Purpose: Late onset neonatal hypocalcemia (LNH) is defined as hypocalcemia detected after day 3 of life. Its occurrence in babies fed with cow’s milk is well understood. Since the advent of modern-day formulas, the incidence has however decreased. Methods: A prospective descriptive study (January 2017 to December 2017) of LNH seizures in neonates was conducted. LNH was defined as the total serum calcium of less than 7 mg/dL in preterm or less than 8 mg/dL in term newborns after 72 h of life. Results: 14 neonates were presented with myoclonic and focal seizures due to late hypocalcemia. All were formula fed. Their mean serum calcium, phosphorus, alkaline phosphatase, magnesium, 25-OH vitamin D, intact PTH levels were 4.93 mg/dL, 9.19 mg/dL, 244 U/L, 1.2 mg/dL, 30 nmol/L, 38.6 pg/mL, respectively. Mean maternal vitamin D levels were 43 nmol/L. Mean hospital stay was 4 days. Clinical response to treatment was brisk in those who were able to shift to total breast feeding early. Conclusions: LNH in formula-fed and vitamin D deficient babies is not uncommon. Emphasis should be laid on exclusive breast feeding even in vitamin D deplete mothers. However, mothers at risk should be supplemented with vitamin D during pregnancy.

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