The American journal of emergency medicine
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A 21year-old male presented to the emergency department with 6 h of atypical chest pain after suffering blunt chest trauma. His electrocardiogram revealed 1-1.5mm ST segment elevation in leads V1-V3 with reciprocal depressions in II, III, and aVF. ⋯ A left main coronary artery dissection was diagnosed and treated surgically with a bypass graft. Although rare, coronary dissections can be a catastrophic complication of chest trauma.
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Case Reports
Acute symptomatic hypocalcemia from immune checkpoint therapy-induced hypoparathyroidism.
Ipilimumab (a monoclonal antibody against CTLA-4) and nivolumab (a humanized antibody against PD-1) target these immune checkpoint pathways and are used for treatment of melanoma and an increasing number of other cancers. However, they may cause immune-related adverse effects (IRAEs). Although many endocrinopathies are known to be IRAEs, primary hypoparathyroidism with severe hypocalcemia has never been reported. This is the first case of hypoparathyroidism as an IRAE presenting to an Emergency Department with acute hypocalcemia. ⋯ Primary hypoparathyroidism caused by ipilimumab and nivolumab may acute manifest with severe symptomatic hypocalcemia. Emergency care providers should be aware of hypoparathyroidism as a new IRAE in this new era of immuno-oncology.
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Characteristic ECG changes with hypercalcemia include shortening of the QoT, QaT, and QeT intervals which are measured from the beginning of the QRS complex to the origin (O), apex (A), and end (E) of the T wave respectively. At very high serum calcium levels ECG changes include slight prolongation of the PR and QRS intervals, T wave flattening or inversion, and the appearance of a J wave at the end of the QRS complex. ⋯ Cardiac troponin testing was negative, however, laboratory testing revealed a serum calcium level of 15mg/dL (normal 7.3-10.5mg/dL). We review the published literature regarding the link between hypercalcemia and the appearance of ST elevation.
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Decreased level of serum calcium was commonly seen in critical illness. Hypocalcemia was significantly more frequent in patients with severe form of acute pancreatitis (AP), and a negative correlation was observed between endotoxemia and serum calcium in AP. AP patients with persistent organ failure (POF) show an extremely high mortality. The association underlying calcium and POF in AP has not been characterized. ⋯ Our results indicate that serum calcium on admission is independently associated with POF in AP and may serve as a potential prognostic factor.