Maintenance of Ionized Calcium During Prolonged Extreme Massive Transfusion During Liver Transplantation.

Q3 Medicine
Wisconsin Medical Journal Pub Date : 2023-09-01
Ricardo P Dorantes, Stylianos Voulgarelis, Harvey J Woehlck
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引用次数: 0

Abstract

Introduction: Massive transfusion may cause ionized hypocalcemia, a complication that, when severe, causes hemodynamic instability. Extant literature fails to provide effective guidance on replacement strategies to avoid severe ionized hypocalcemia in the most extreme situations.

Case presentation: We discuss a liver transplant in which our empiric calcium replacement strategy resulted in no critically low ionized calcium values during the pre-reperfusion phase of a liver transplant with over 140 000 mL of bank blood transfusion, with an average of 10 000 mL per hour for 14 hours.

Discussion: Few comparable reports exist. Most rely upon monitoring with subsequent replacement, but these have not been effective at avoiding severely low ionized calcium values.

Conclusions: Our empiric calcium replacement strategy of 1 gram of calcium chloride per liter of citrated bank blood transfused, in 200 mg/200 mL increments, resulted in successful maintenance of ionized calcium during the anhepatic phase of liver transplantation while on continuous veno-venous hemofiltration.

肝移植过程中长时间极大量输注过程中电离钙的维持。
引言:大量输血可能导致电离性低钙血症,严重时会导致血液动力学不稳定。现有文献未能为在最极端的情况下避免严重的电离低钙血症的替代策略提供有效的指导。病例介绍:我们讨论了一例肝移植,其中我们的经验钙替代策略在超过140例的肝移植再灌注前阶段没有导致严重的低电离钙值 000毫升的银行输血,平均10 000mL/小时,持续14小时。讨论:几乎没有类似的报告。大多数都依赖于后续更换的监测,但这些都无法有效避免电离钙值严重偏低。结论:我们的经验钙替代策略是,每升输注柠檬酸盐基血1克氯化钙,增量为200 mg/200 mL,在肝移植的无肝期,在持续的静脉-静脉血液过滤中,成功地维持了电离钙。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Wisconsin Medical Journal
Wisconsin Medical Journal Medicine-Medicine (all)
CiteScore
1.30
自引率
0.00%
发文量
72
期刊介绍: The Wisconsin Medical Society is the largest association of medical doctors in the state with more than 12,000 members dedicated to the best interests of their patients. With that in mind, wisconsinmedicalsociety.org offers patients a unique source for reliable, physician-reviewed medical information. The Wisconsin Medical Society has been a trusted source for health policy leadership since 1841.
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