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Title: Utility of calcium, magnesium and phosphate testing in the emergency department.
Austin Authors: Date, Patrick A ;Smith, Jesse L;Spencer, William S;de Tonnerre, Erik J;Yeoh, Michael J ;Taylor, David McD 
Affiliation: Austin Health
Northern Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia
Alfred Health, Melbourne, Victoria, Australia
Central Gippsland Health, Sale, Victoria, Australia
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Feb-2020
Date: 2019-06-02
Publication information: Emergency Medicine Australasia : EMA 2020; 32(1): 39-44
Abstract: To determine how frequently calcium (Ca), magnesium (Mg) and phosphate (PO4 ) tests change ED patient management. We undertook a retrospective observational study in an Australian tertiary referral ED. We enrolled adult patients (aged ≥18 years) who presented between 1 January and 30 June 2017 and who had a serum Ca, Mg or PO4 test ordered and completed during their ED stay. Patient symptoms, medical history, electrolyte levels and ED management changes were extracted from the electronic medical record. Of the 33 120 adults presented during the study period, 1716 (5.2%, 95% confidence interval [CI] 5.0-5.4) had at least one Ca, Mg or PO4 test completed in the ED. This included 4776 individual electrolyte tests, of which 776 (16.2%, 95% CI 15.2-17.3) were abnormal. Fifty-six (7.2% [95% CI 5.5-9.3] of patients with abnormal tests, 1.2% [95% CI 0.9-1.5] of all tests) tests were associated with a change in ED management. Twenty-six out of 1683 (1.5%) Ca levels were low with six (23.1%) management changes; 203 (12.1%) were high with 10 (4.9%) management changes. One hundred and twenty-eight out of 1579 (8.1%) Mg levels were low with 33 (25.8%) management changes; 30 (1.9%) were high with no management changes. Two hundred and twenty-five out of 1514 (14.9%) PO4 levels were low with six (2.7%) management changes; 164 (10.8%) were high with one (0.6%) management change. Fifty (2.9%) patients had management changes despite normal electrolyte levels. Ca, Mg and PO4 testing is common. However, the yield of clinically significant abnormal levels is low and patient management is rarely changed. Testing of these electrolytes needs to be rationalised.
DOI: 10.1111/1742-6723.13332
ORCID: 0000-0002-8986-9997
Journal: Emergency Medicine Australasia : EMA
PubMed URL: 31155837
Type: Journal Article
Subjects: calcium
choosing wisely
emergency health service
Appears in Collections:Journal articles

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