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Adverse Effects of Calcium Administration: Report of Two Cases

Adverse Effects of Calcium Administration: Report of Two Cases Abstract • Calcium chloride, 7 mg/kg, and calcium gluconate, 20 mg/kg, were administered to patients with low or low-normal levels of serum ionized calcium. Both patients had low blood pressure and cardiac index, and did not respond to digitalis, volume expansion, and β-adrenergic stimulation with dopamine. Administration of calcium caused rapid increase of serum ionized calcium levels, decrease of serum potassium levels, and development of severe cardiac arrhythmias. Atrioventricular dissociation and further fall of cardiac index and blood pressure were common features of both cases. Administration of exogenous calcium can cause severe complications, even when theoretically indicated. (Arch Surg 113:882-885, 1978) References 1. White RD, Goldsmith RS, Rodriguez R, et al: Plasma ionic calcium levels following injection of chloride, gluconate, and gluceptate salts of calcium . J Thorac Cardiovasc Surg 71:609-613, 1976. 2. Holcroft JW, Trunkey DD, Carpenter MA: Calcium shifts during hemorrhagic shock in baboons . Surg Forum 40:66-68, 1974. 3. Drop LJ, Laver MB: Low plasma ionized calcium and response to calcium therapy in critically ill man . Anesthesiology 43:300-306, 1975.Crossref 4. Fleckenstein A, Janke J, Doring HJ, et al: Ca overload as the determination factor in the production of catecholamine-induced myocardial lesions . Rec Adv Stud Cardiol Struct Metab 3:455-466, 1972. 5. Fleckenstein A, Janke J, Doring HJ, et al: Key role of Ca in the production of noncoronarogenic myocardial necroses . Rec Adv Stud Cardiol Struct Metab 6:21-31, 1975. 6. Williamson JR, Schaffer S: Epinephrine, cyclic-AMP, calcium and myocardial contractility . Rec Adv Stud Cardiol Struct Metab 9:205-223, 1976. 7. Kones RJ: The catecholamines: Reappraisal of their use for acute myocardial infarction and the low cardiac output syndromes . Crit Care Med 1:203-220, 1973.Crossref 8. Berk JL: Use of vasoactive drugs in the treatment of shock . Surg Clin North Am 55:721-728, 1975. 9. Berk JL, Hagen JF, Maly G, et al: The treatment of shock with a β-adrenergic blockage . Arch Surg 104:46-51, 1972.Crossref 10. Howland WS, Schweizer O, Carlon GC, et al: The cardiovascular effects of low levels of ionized calcium during massive transfusion . Surg Gynecol Obstet 145:581-586, 1977. 11. Aldinger AK, Samaan AN: Hypokalemia and hypercalcemia . Ann Intern Med 87:571-573, 1977.Crossref 12. Peach MJ: Cations: Calcium, magnesium, barium, lithium, and ammonium , in Goodman LS, Gillman A: The Pharmacological Basis of Therapeutics . New York, Macmillan Publishing Co, 1975, pp 782-797. 13. Wylie WD, Churchill-Davidson HL: A Practice of Anesthesia . New York, Year Book Medical Publishers, 1975, p 747. 14. Howland WS, Schweizer O, Jascott DJ, et al: Factors influencing the ionization of calcium during major surgical procedures . Surg Gynecol Obstet 143:895-900, 1976. 15. Howland WS, Bellville JW, Zucker MB, et al: Massive blood replacement . Surg Gynecol Obstet 105:529-540, 1957. 16. Howland WS, Schweizer O, Ragasa J, et al: Colloid oncotic pressure and levels of albumin and total protein during major surgical procedures . Surg Gynecol Obstet 14:592-596, 1976 17. Getzen LC, Pollak EW, Wolfman EF: Serum protein concentration during hemorrhagic shock . Surg Gynecol Obstet 144:42-44, 1977. 18. Tullis JL: Albumin: Background and use . JAMA 237:355-360, 460-462, 1977.Crossref 19. Lembeck F, Juan H: Are there therapeutic indications of intravenous injection of calcium gluconate? Arzneim Forsch 25:1570-1574, 1975. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1978.01370190104021
Publisher site
See Article on Publisher Site

Abstract

Abstract • Calcium chloride, 7 mg/kg, and calcium gluconate, 20 mg/kg, were administered to patients with low or low-normal levels of serum ionized calcium. Both patients had low blood pressure and cardiac index, and did not respond to digitalis, volume expansion, and β-adrenergic stimulation with dopamine. Administration of calcium caused rapid increase of serum ionized calcium levels, decrease of serum potassium levels, and development of severe cardiac arrhythmias. Atrioventricular dissociation and further fall of cardiac index and blood pressure were common features of both cases. Administration of exogenous calcium can cause severe complications, even when theoretically indicated. (Arch Surg 113:882-885, 1978) References 1. White RD, Goldsmith RS, Rodriguez R, et al: Plasma ionic calcium levels following injection of chloride, gluconate, and gluceptate salts of calcium . J Thorac Cardiovasc Surg 71:609-613, 1976. 2. Holcroft JW, Trunkey DD, Carpenter MA: Calcium shifts during hemorrhagic shock in baboons . Surg Forum 40:66-68, 1974. 3. Drop LJ, Laver MB: Low plasma ionized calcium and response to calcium therapy in critically ill man . Anesthesiology 43:300-306, 1975.Crossref 4. Fleckenstein A, Janke J, Doring HJ, et al: Ca overload as the determination factor in the production of catecholamine-induced myocardial lesions . Rec Adv Stud Cardiol Struct Metab 3:455-466, 1972. 5. Fleckenstein A, Janke J, Doring HJ, et al: Key role of Ca in the production of noncoronarogenic myocardial necroses . Rec Adv Stud Cardiol Struct Metab 6:21-31, 1975. 6. Williamson JR, Schaffer S: Epinephrine, cyclic-AMP, calcium and myocardial contractility . Rec Adv Stud Cardiol Struct Metab 9:205-223, 1976. 7. Kones RJ: The catecholamines: Reappraisal of their use for acute myocardial infarction and the low cardiac output syndromes . Crit Care Med 1:203-220, 1973.Crossref 8. Berk JL: Use of vasoactive drugs in the treatment of shock . Surg Clin North Am 55:721-728, 1975. 9. Berk JL, Hagen JF, Maly G, et al: The treatment of shock with a β-adrenergic blockage . Arch Surg 104:46-51, 1972.Crossref 10. Howland WS, Schweizer O, Carlon GC, et al: The cardiovascular effects of low levels of ionized calcium during massive transfusion . Surg Gynecol Obstet 145:581-586, 1977. 11. Aldinger AK, Samaan AN: Hypokalemia and hypercalcemia . Ann Intern Med 87:571-573, 1977.Crossref 12. Peach MJ: Cations: Calcium, magnesium, barium, lithium, and ammonium , in Goodman LS, Gillman A: The Pharmacological Basis of Therapeutics . New York, Macmillan Publishing Co, 1975, pp 782-797. 13. Wylie WD, Churchill-Davidson HL: A Practice of Anesthesia . New York, Year Book Medical Publishers, 1975, p 747. 14. Howland WS, Schweizer O, Jascott DJ, et al: Factors influencing the ionization of calcium during major surgical procedures . Surg Gynecol Obstet 143:895-900, 1976. 15. Howland WS, Bellville JW, Zucker MB, et al: Massive blood replacement . Surg Gynecol Obstet 105:529-540, 1957. 16. Howland WS, Schweizer O, Ragasa J, et al: Colloid oncotic pressure and levels of albumin and total protein during major surgical procedures . Surg Gynecol Obstet 14:592-596, 1976 17. Getzen LC, Pollak EW, Wolfman EF: Serum protein concentration during hemorrhagic shock . Surg Gynecol Obstet 144:42-44, 1977. 18. Tullis JL: Albumin: Background and use . JAMA 237:355-360, 460-462, 1977.Crossref 19. Lembeck F, Juan H: Are there therapeutic indications of intravenous injection of calcium gluconate? Arzneim Forsch 25:1570-1574, 1975.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1978

References