Hypocalcemia and Neurologic ICU Patients

Laura Lee

Date of Award

2009

Document Type

Thesis

College/School

College of Nursing

Degree Name

Master of Science in Nursing (MSN)

Program Concentration

Family Nurse Practitioner

Abstract

Background. Hypocalcemia is a common electrolyte imbalance in critically ill patients with an incidence as high as 88%. The exact cause of hypocalmia in ICU patients is unknown, but is believed to be multi factorial in origin including factors such as systemic immune response, hemodilution, calcium chelation from blood administration and hypothalamic dysfunction. Severe and untreated hypocalcemia can lead to tetany and cardiac arrhythmias. Current treatment regimens vary, and many studies show that calcium supplementation does nothing to relieve the condition. Swedish Medical Center currently treats hypocalcemia with supplemental calcium gluconate. Purpose. The purpose of this study was to evaluate cost and efficacy of calcium supplementation in hypocalcemic neurologic IC patients at Swedish Medical Center Cherry Hill. The specific objectives were: (1) To determine the incidence of hypocalcemia in neurologic and cardiac ICUs at Swedish Medical Center; (2) To determine the treatment rate of patients diagnosed with hypocalcemia; (3) To determine effectiveness of hypocalcemia treatment; and, (4) To determine an average cost of treating hypocalcemia in ICU patients. Methods. Following IRB approval, a retrospective chart review was used to obtain data on patient demographics, laboratory values, diagnosis and outcomes. Descriptive statistics were used to analyze the data and paired sample t-tests were used to test for significant changes in calcium levels across time. General cost data for calcium testing and supplementation was obtained from Swedish Medical Center's pharmacy and laboratory. Findings. 67.8% of subjects exhibited hypocalcemia. Treatment occurred at a rate of 66.1%, but did not have a statistically significant affect on raising the serum iCa level into a normal range. Average cost of treating hypocalcemia in this study population was $1789.80. Conclusion. Calcium supplementation did not increase the iCa values in the majority of patients. Questions remain regarding whether calcium supplementation garners benefits, confers harm, or simply uses resources inappropriately.

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