Endocrine Abstracts

Background: Acute hypercalcaemia of biochemical and symptomatic nature is a relatively common emergency medical presentation. Its management has tended to vary significantly and this can affect patient’s outcomes and length of hospital stay.

Aim: To assess the acute management of hypercalcaemia in relation to the new Society for Endocrinology guidance.

Method: A retrospective audit of all cases of hypercalcaemia admitted to Oxford University Hospitals emergency departments in 2015, using the SfE guidance as our audit standards.

Results: We discovered 41 patients had a coded diagnosis of hypercalcaemia. The average age ranging between 45 to 99 years old, 19 female patients and 22 male patients; 36% had a diagnosis of malignancy, 30% primary hyperparathyroidism and in 24% no cause for hypercalcaemia was identified. In terms of acute management, 90% of patients were treated with IV fluids and appropriately rehydrated, 35% received IV biphosphonates. Only 20% were reviewed by an endocrinologist; 100% had their renal function checked, but only 25% PTH and 25% vitamin D checked.

Discussion: Specific examinations in terms of assessment of fluid balance status, cognitive impairment and examination for underlying causes were sub-optimal in the majority of cases.

Conclusion: The majority of patients presenting with acute hypercalcaemia were well managed but there are obvious deficits and room for improvement in terms of adequate clinical assessment, ensuring the entire correct baseline investigations have been completed and arranging specialist Endocrinology review where appropriate. We plan to promote the SfE guidance locally in AE and AMU, update the trust guidance and medicine information leaflet through education, training and the electronic automated system (EPR).