Low serum total calcium concentration as a marker of low serum ionized calcium concentration in critically ill patients receiving specialized nutrition support

Roland Dickerson, Natohya Y. Henry, Patrice L. Miller, Gayle Minard, Rex Brown

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: The intent of this study was to ascertain to what extent serum total calcium concentration (tCa) <7 mg/dL reflects hypocalcemia (defined by ionized calcium concentration [iCa] of ≤1.12 mmol/L) in critically ill patients receiving specialized nutrition support. Methods: Adult patients (≥18 years) admitted to the trauma, surgical, medical, burn, or neurosurgical intensive care units, trauma stepdown unit, or progressive care unit and referred to the nutrition support service were retrospectively identified for potential inclusion into the study. Serum chemistries, arterial blood gas measurements, nutrition markers, and serum iCa were simultaneously obtained from each patient approximately 1 day after initiation of specialized nutrition support. Patients with a serum creatinine ≥2 mg/dL, hyperphosphatemia (≥6 mg/dL), severe hypomagnesemia (≤1.12 mg/dL), history of metabolic bone disease, or parathyroid disease were excluded from the analysis. Results: One hundred ninety-five patients (91% who had multiple trauma, with a mean Injury Severity Score 31 ± 13) were enrolled into the study. Specialized nutrition support was initiated 2.8 ± 1.8 days and calcium status was studied 4.2 ± 3.1 days after hospital admission, respectively. The majority (28 of 33, or 85%) of patients with a tCa <7 mg/dL were hypocalcemic compared with 33% (22 out of 66) of patients with a tCa of 7-7.4 mg/dL, and 11% (11 of 96) of those with a tCa of 7.5-7.9 mg/dL (p < .001). Conclusions: Critically ill patients with a serum total calcium concentration of <7 mg/dL have a high rate of hypocalcemia (iCa ≤1.12 mmol/L). Hypocalcemia, defined as a serum iCa of ≤1.12 mmol/L, occurs in 85% of acutely ill patients with a serum tCa <7 mg/dL.

Original languageEnglish (US)
Pages (from-to)323-328
Number of pages6
JournalNutrition in Clinical Practice
Volume22
Issue number3
DOIs
StatePublished - Dec 1 2007

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Critical Illness
Biomarkers
nutrition
Calcium
calcium
Serum
hypocalcemia
Hypocalcemia
parathyroid diseases
Parathyroid Diseases
developmental orthopedic disease
hypomagnesemia
Hyperphosphatemia
blood chemistry
Injury Severity Score
Metabolic Bone Diseases
Multiple Trauma
Trauma Centers
blood gases
creatinine

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Low serum total calcium concentration as a marker of low serum ionized calcium concentration in critically ill patients receiving specialized nutrition support. / Dickerson, Roland; Henry, Natohya Y.; Miller, Patrice L.; Minard, Gayle; Brown, Rex.

In: Nutrition in Clinical Practice, Vol. 22, No. 3, 01.12.2007, p. 323-328.

Research output: Contribution to journalArticle

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abstract = "Background: The intent of this study was to ascertain to what extent serum total calcium concentration (tCa) <7 mg/dL reflects hypocalcemia (defined by ionized calcium concentration [iCa] of ≤1.12 mmol/L) in critically ill patients receiving specialized nutrition support. Methods: Adult patients (≥18 years) admitted to the trauma, surgical, medical, burn, or neurosurgical intensive care units, trauma stepdown unit, or progressive care unit and referred to the nutrition support service were retrospectively identified for potential inclusion into the study. Serum chemistries, arterial blood gas measurements, nutrition markers, and serum iCa were simultaneously obtained from each patient approximately 1 day after initiation of specialized nutrition support. Patients with a serum creatinine ≥2 mg/dL, hyperphosphatemia (≥6 mg/dL), severe hypomagnesemia (≤1.12 mg/dL), history of metabolic bone disease, or parathyroid disease were excluded from the analysis. Results: One hundred ninety-five patients (91{\%} who had multiple trauma, with a mean Injury Severity Score 31 ± 13) were enrolled into the study. Specialized nutrition support was initiated 2.8 ± 1.8 days and calcium status was studied 4.2 ± 3.1 days after hospital admission, respectively. The majority (28 of 33, or 85{\%}) of patients with a tCa <7 mg/dL were hypocalcemic compared with 33{\%} (22 out of 66) of patients with a tCa of 7-7.4 mg/dL, and 11{\%} (11 of 96) of those with a tCa of 7.5-7.9 mg/dL (p < .001). Conclusions: Critically ill patients with a serum total calcium concentration of <7 mg/dL have a high rate of hypocalcemia (iCa ≤1.12 mmol/L). Hypocalcemia, defined as a serum iCa of ≤1.12 mmol/L, occurs in 85{\%} of acutely ill patients with a serum tCa <7 mg/dL.",
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N2 - Background: The intent of this study was to ascertain to what extent serum total calcium concentration (tCa) <7 mg/dL reflects hypocalcemia (defined by ionized calcium concentration [iCa] of ≤1.12 mmol/L) in critically ill patients receiving specialized nutrition support. Methods: Adult patients (≥18 years) admitted to the trauma, surgical, medical, burn, or neurosurgical intensive care units, trauma stepdown unit, or progressive care unit and referred to the nutrition support service were retrospectively identified for potential inclusion into the study. Serum chemistries, arterial blood gas measurements, nutrition markers, and serum iCa were simultaneously obtained from each patient approximately 1 day after initiation of specialized nutrition support. Patients with a serum creatinine ≥2 mg/dL, hyperphosphatemia (≥6 mg/dL), severe hypomagnesemia (≤1.12 mg/dL), history of metabolic bone disease, or parathyroid disease were excluded from the analysis. Results: One hundred ninety-five patients (91% who had multiple trauma, with a mean Injury Severity Score 31 ± 13) were enrolled into the study. Specialized nutrition support was initiated 2.8 ± 1.8 days and calcium status was studied 4.2 ± 3.1 days after hospital admission, respectively. The majority (28 of 33, or 85%) of patients with a tCa <7 mg/dL were hypocalcemic compared with 33% (22 out of 66) of patients with a tCa of 7-7.4 mg/dL, and 11% (11 of 96) of those with a tCa of 7.5-7.9 mg/dL (p < .001). Conclusions: Critically ill patients with a serum total calcium concentration of <7 mg/dL have a high rate of hypocalcemia (iCa ≤1.12 mmol/L). Hypocalcemia, defined as a serum iCa of ≤1.12 mmol/L, occurs in 85% of acutely ill patients with a serum tCa <7 mg/dL.

AB - Background: The intent of this study was to ascertain to what extent serum total calcium concentration (tCa) <7 mg/dL reflects hypocalcemia (defined by ionized calcium concentration [iCa] of ≤1.12 mmol/L) in critically ill patients receiving specialized nutrition support. Methods: Adult patients (≥18 years) admitted to the trauma, surgical, medical, burn, or neurosurgical intensive care units, trauma stepdown unit, or progressive care unit and referred to the nutrition support service were retrospectively identified for potential inclusion into the study. Serum chemistries, arterial blood gas measurements, nutrition markers, and serum iCa were simultaneously obtained from each patient approximately 1 day after initiation of specialized nutrition support. Patients with a serum creatinine ≥2 mg/dL, hyperphosphatemia (≥6 mg/dL), severe hypomagnesemia (≤1.12 mg/dL), history of metabolic bone disease, or parathyroid disease were excluded from the analysis. Results: One hundred ninety-five patients (91% who had multiple trauma, with a mean Injury Severity Score 31 ± 13) were enrolled into the study. Specialized nutrition support was initiated 2.8 ± 1.8 days and calcium status was studied 4.2 ± 3.1 days after hospital admission, respectively. The majority (28 of 33, or 85%) of patients with a tCa <7 mg/dL were hypocalcemic compared with 33% (22 out of 66) of patients with a tCa of 7-7.4 mg/dL, and 11% (11 of 96) of those with a tCa of 7.5-7.9 mg/dL (p < .001). Conclusions: Critically ill patients with a serum total calcium concentration of <7 mg/dL have a high rate of hypocalcemia (iCa ≤1.12 mmol/L). Hypocalcemia, defined as a serum iCa of ≤1.12 mmol/L, occurs in 85% of acutely ill patients with a serum tCa <7 mg/dL.

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