PURPOSE: Immobilisation may be associated with excessive bone resorption leading to hyperealcemia and its complications such as delirium, renal failure and bowel dysfunction. Incidence, risk factors as well as clinical consequences of immobilisation-associated hyperealcemia are not known for patients with extended intensive care unit (ICU) stay. This retrospective cohort study was designed to evaluate the incidence as well as the risk factors of hypercalcemia for adult patients with extended (more than 28 days) ICU stay.
METHODS: All medical records of adult patients with an ICU stay of more than 28 days from 2002 to 2005 were reviewed. For each patient, the highest ionized calcemia was noted as well as the following informations: age, gender, race, weight, admission diagnosis, date of highest ionized calcemia with its associated creatinine level, diagnosis of septic shock, diagnosis of acute respiratory distress syndrome (ARDS), continuous veno-venous hemofiltration (CVVH), mechanical ventilation, parenteral nutrition, and corticotherapy.
RESULTS: Seventy-nine patients stayed in ICU for more than 28 days. Mean age was 53 [+ or -] 18 year-old. Twelve patients (15%) died. 59 patients (75%) had mechanical ventilation, 13 (16%) had CVVH, 29 (37%) had ARDS. Sixteen patients (20%) had hypercalcemia with a mean ionized calcemia of 1,44 [+ or -] 0,13 mmol/L (normal 1,15-1,29 mmol/L). Twelve of these patients were under CVVH.
CONCLUSION: Hypercalcemia is frequent in patients with extended ICU stay. CVVH seems to be strongly associated with hypercalcemia. For those patients under CVVH, hypercalcemia may be explained by the high calcium concentration in our reinjection solutions (1,75 mmol/L). A prospective study is needed to determine the real incidence of immobilisation-associated hypercalcemia in patients without CVVH.
CLINICAL IMPLICATIONS: Clinicians may considered looking at ionized calcemia in patients with extended ICU stay.
DISCLOSURE: Nathalie Gagnon, None.
Nathalie Gagnon MD * Francois Lauzier MD Francois J. LeBlanc MD Laval University, Quebec, PQ, Canada
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group
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