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Arterial Blood Ca2+ Levels, Cardiac and Respiratory Function

  • B. W. Allen
  • G. G. Somjen

Abstract

In 1944, Allen and his colleagues [1] reported on the tolerance for citrated blood and blood plasma in humans and dogs, and assumed: “The toxic effects of citrate… to be attributable primarily to the immobilization of calcium ion.” These investigators found the lethal dose of citrate in the dog to be 0.30 g/kg (1.02mmol/kg) body weight administered in 15 min or less. However, they concluded that such toxicity was unlikely to occur in human patients with the rates at which citrated blood (containing 5.0 g/1,17.00 mmol/1 citrate) was then being administered in surgical practice, i. e., 1500–2500 ml over 2–6 h. However, in the late 1940s and in the early 1950s, there was renewed interest in this question since new procedures, such as exchange transfusion and surgical treatment of bleeding esophogeal varices, came to be employed. These and other procedures required transfusions of larger volumes (2000–8000 ml) of blood, often in 15 min or less [3]. Bunker and his colleagues [3,4] studied the hemodynamic and cardiovascular effects of citrated blood in human patients receiving such massive transfusions, and investigated the effect of citrate administration in dogs, in order to learn the relationship between citrate levels, plasma ionized calcium, and cardiac function in vivo. They measured total calcium, total protein, and other variables, in blood samples with bench instruments, and estimated plasma ionized calcium using the nomogram of McLean and Hastings [10]. Bunker and his group concluded that significant cardiovascular disturbances could occur under these conditions. Today, each unit (550 ml) of citrate-preserved blood contains 1.08 mmol citrate, or 0.015 mmol per liter total blood volume for a 70 kg patient for each unit of blood transfused [12]. In some surgical procedures, 5 U or more may be transfused [8, 9], resulting in a significant dose of citrate.

Keywords

Pulse Pressure Cardiac Rate Massive Transfusion Citrate Blood Bilateral Vagotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Allen JG, Clark DE, Thornton TF, Adams WE (1944) The transfusion of massive volumes of citrated whole blood and plasma in man. Surgery 15: 824–831Google Scholar
  2. 2.
    Bronsky D, Dubin A, Waldstein SS, Kushner DS (1961) Calcium and the electrocardiogram: I. The electrocardiographic manifestations of hypoparathyroidism. Am J Cardiol 7: 823–832CrossRefGoogle Scholar
  3. 3.
    Bunker JP, Stetson JB, Coe RC, Grillo HC, Murphy AJ (1955) Citric Acid intoxication. JAMA 157:1361–1367Google Scholar
  4. 4.
    Bunker JP, Bendixen HH, Murphy AJ (1962) Hemodynamic effects of intravenously administered sodium citrate. N Engl J Med 266: 372–377PubMedCrossRefGoogle Scholar
  5. 5.
    Colletti RB, Pan MW, Smith EWP, Genel M (1974) Detection of hypocalcemia in susceptible neonates, the QO-Tc interval. N Engl J Med 290: 931–935PubMedCrossRefGoogle Scholar
  6. 6.
    Fogt EJ, Eddy AR, Clemens AH, Fox J, Heath H (1980) Use of electrochemical sensors for online monitoring of ionized calcium, potassium, and glucose in whole blood of living dogs. Clin Chem 26:1425–1429PubMedGoogle Scholar
  7. 7.
    Hayes JK, Bremer RA, Wong KC, Jordan WS, Westenskow DR (1980) Continuous monitoring of serum ionized calcium in the dog during sodium citrate infusion using an extracorporeal blood shunt. Canad Anaesth Soc J 27: 458–463PubMedCrossRefGoogle Scholar
  8. 8.
    Howland WS, Schweizer O, Graziano CC, Goldiner PL (1977) The cardiovascular effects of low levels of ionized calcium during massive transfusion. Surg Gynecol Obstet 145: 581–586PubMedGoogle Scholar
  9. 9.
    Kahn RC, Jascott D, Graziano CC, Schweizer O, Howland WS, Goldiner PL (1979) Massive blood replacement: correlation of ionized calcium, citrate, and hydrogen ion concentration. Anesth Analg (Cleve) 58: 274–278Google Scholar
  10. 10.
    McLean FC, Hastings AB (1934) The state of calcium in the fluids of the body: I. The conditions affecting the ionization of calcium. J Biol Chem 108: 285–322Google Scholar
  11. 11.
    Stultz PM, Scheidegger D, Drop LJ, Lowenstein E, Laver MB (1979) Ventricular pump performance during hypocalcemia, clinical and experimental studies. J Thorac Cardiovasc Surg 78: 185–194Google Scholar
  12. 12.
    United States Pharmacopeia, 20th revision (1980), p 49Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • B. W. Allen
  • G. G. Somjen

There are no affiliations available

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