The role of calcium in intravenous fluid therapy.

Abstract

In general, the maintenance of calcium balance is an accepted part by the fluid and electrolyte management of patients. In the medium to long term, there are clear adverse effects of consistent negative or positive calcium balance, and both hypoand hypercalcaemia are associated with morbidity (Agus & Goldfarb, 1985). In these circumstances, monitoring of the plasma calcium concentration, and judicious use of intravenous or oral supplements, together with vitamin D analogues if required (as in renal failure), is appropriate. However, the short-term use of intravenous calcium supplementation in acutely ill patients remains a topic of controversy. For many years, the administration of intravenous calcium was a routine part of the resuscitation regime for traumatic, haemorrhagic, or cardiogenic shock. This was based on the high incidence of acute hypocalcaemia in these conditions, and the observed beneficial effects of calcium on systemic haemodynamics (Denis et al., 1985). A number of the fluid preparations available for acute intravenous use contain supplemental calcium, including crystalloids (e.g. Ringer's solution, 2.2 mmol 1I calcium) and colloids (e.g. Haemaccel, 6.25 mmol I1 calcium; Hoechst UK Ltd, Middlesex, UK). However, the use of intravenous calcium in these situation has been questioned, largely on the basis of the known increase in intracellular calcium concentration which occurs during ischaemic cellular injury (Trunkey et al., 1976).