Mortality and reproducibility of calcium
measurements in patients with hypercalcemia
reporting to the emergency department of a
tertiary German hospital

Mortality and reproducibility of calcium
measurements in patients with hypercalcemia
reporting to the emergency department of a
tertiary German hospital

Hypercalcemia, Reproducibility, Mortality, Calcium measurement, Germany

Abstract
Background Severe hypercalcemia often results in the referral of patients to the emergency department (ED), as
life-threatening consequences are feared. However, the available literature concerning the causes of hypercalcemia,
mortality and therapeutic responses in these patients is scarce.
Methods We retrospectively analyzed a cohort of 1310 patients with a total serum calcium concentration≥2.65
mmol/l, who reported to the ED of the University Hospital Cologne, Germany, between January 1st, 2010, and
March 31st, 2021, for any reason, investigating hypercalcemia-associated diagnoses, ECG changes, symptoms of
hypercalcemia, the course of calcium values over the first 5 days and hospital mortality.
Results The most common causes of hypercalcemia were malignancies, primary hyperparathyroidism and
dehydration. Patients with sarcoidosis and vitamin D intoxication had the highest mean calcium levels at
presentation. In patients with mild hypercalcemia, elevated total calcium values were often not reproducible in
consecutive samples. Hypercalcemia due to dehydration, sepsis and subsequent to cardiopulmonary resuscitation
(CPR) resulted in lower mean calcium levels, which quickly normalized in the following days. Hypercalcemia was
well controlled with the applied therapies, even in the majority of patients who died during their hospital stay. We
found no major abnormalities in the ECG analysis, and no death due to cardiac arrhythmias was documented in the
patient charts. The mortality rate of patients varied greatly depending on the cause of hypercalcemia. Patients with
malignancies had high mortality irrespective of total calcium levels at admission, whereas patients with sarcoidosis
and hyperparathyroidism had low mortality despite high calcium levels.
Conclusion We found no evidence for acute death due to hypercalcemia. The degree of hypercalcemia might not
be the main factor influencing mortality in these patients. Given that mild hypercalcemia is often not reproducible in
consecutive blood samples, persistent hypercalcemia should be confirmed before further work-up is initiated.
Keywords Hypercalcemia, Reproducibility, Mortality, Calcium measurement, Germany

Franziska M. Himmels1,2, Annika Krane1,2, Thomas Osterholt1,2 , Christoph Hüser1,2, Victor Suárez1,2 ,
Volker R. Burst1,2 and Matthias J. Hackl1,2*

https://doi.org/10.1186/s12245-025-01052-6

2025

Peri Irawan

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