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Identification of Predictors of Abnormal Calcium, Magnesium and Phosphorus Blood Levels in the Emergency Department: A Retrospective Cohort Study

Authors Lapointe A, Royer Moreau N, Simonyan D, Rousseau F, Mallette V, Préfontaine-Racine F, Paquette C, Mallet M, St-Pierre A, Berthelot S

Received 31 October 2020

Accepted for publication 22 December 2020

Published 18 January 2021 Volume 2021:13 Pages 13—21

DOI https://doi.org/10.2147/OAEM.S289748

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape


Antoine Lapointe,1 Nikyel Royer Moreau,1 David Simonyan,2 François Rousseau,2 Viviane Mallette,1 Frédérique Préfontaine-Racine,1 Caroline Paquette,1 Myriam Mallet,2 Annie St-Pierre,1 Simon Berthelot1,2

1Département de médecine familiale et de médecine d’urgence, Université Laval, Québec, Canada; 2Centre de recherche du CHU de Québec - Université Laval, Québec, Canada

Correspondence: Antoine Lapointe
Département de médecine familiale et de médecine d’urgence, Université Laval, 1050 Avenue de la Médecine, Québec G1V0A6, Canada
Tel +1 418-656-5245
Email Antoine.lapointe.1@ulaval.ca

Purpose: With rising healthcare costs limiting access to care, the judicious use of diagnostic tests has become a critical issue for many jurisdictions. Calcium, magnesium and phosphorus serum levels are regularly performed tests in the emergency department, but their clinical relevance have come into question. Authors sought to determine risk factors that could predict abnormal calcium, magnesium and phosphorus serum levels, as well as identify patients who may need corrective interventions.
Methods: A retrospective cohort study was conducted in two academic hospitals in Québec City. Demographic and clinical characteristics of 1008 patients who had serum calcium and/or magnesium and/or phosphorus levels drawn by an emergency physician were collected. Multivariate logistic regression models were fitted to obtain adjusted odds ratios for each risk factor for abnormal calcium or magnesium or phosphorus blood levels, and for a required intervention.
Results: Among patients for whom calcium, magnesium and phosphorus were tested in the Emergency Department, the most significant risk factors (OR> 2) for electrolytic abnormality were as follows: hypocalcemia – respiratory distress, diuretics (excluding loop and thiazide), anti-neoplastic medication, long QTc, chronic kidney disease (CKD); hypercalcemia – bone pain, vitamin D, hallucinations; hypomagnesemia – diabetes, corticosteroids; hypermagnesemia – poor extremity perfusion, CKD, furosemide; hypophosphatemia – seizure; hyperphosphatemia – phosphate-binders, CKD, peripheral vascular atherosclerotic disease. Of all patients tested, 3.4% received a corrective intervention initiated by the emergency physician. Predictors of intervention on an electrolyte abnormality include poor peripheral perfusion, nausea and chronic obstructive pulmonary disease (COPD).
Conclusion: Emergency physicians can potentially reduce the unnecessary testing of calcium, magnesium and phosphorus blood levels by targeting patients with high-acuity conditions or chronic comorbidities such as CKD, diabetes and COPD.

Keywords: emergency medicine, metabolic, electrolyte, biochemistry

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