title: Electrolyte and acid-base changes with massive blood transfusions.
abstract: The case records of 471 patients with massive transfusions of ten or more units of bank blood within 24 hours were reviewed to analyze the electrolyte and acid-base changes. The patients who lived had a less severe acidosis (7.23 +/- 0.15 vs 7.11 +/- 0.17) and the HCO3 was higher (19.8 +/- 15.2 vs 13.4 +/- 6.8) (P less than 0.001). The mean anion gap, despite the low HCO3, was 11.8 +/- 7.8 mEq/L. A combined metabolic and respiratory acidosis, often following bicarbonate therapy, was fetal in 83 per cent (39/47). Serum potassium values (K) were high in 22 per cent and low in 18 per cent of patients. If potassium levels were "corrected" by subtracting 0.5 mEq/L for each 0.1 pH of metabolic acidosis, only 5 per cent of patients were hyperkalemic. Patients dying within 48 hours of the massive transfusions had higher potassium levels (4.9 +/- 1.1 vs 4.4 +/- 0.9; P less than 0.001). Ionized calcium levels (Ca++) were less than normal (1.13-1.32 mmol/L) in 94 per cent of patients and were very low (less than 0.70 mmol/L) in 46 per cent (108/234). The mortality rate with severe ionic hypocalcemia was 71 per cent (vs 40% in patients with more normal values); P less than 0.0001. pH, PCO2, K, and Ca++ must be followed closely with massive transfusions. Rapid correction of volume and pH, without overcorrection, is essential.
authors.affiliation: Department of Surgery, Detroit Receiving Hospital, Michigan.
authors.forename: R F
authors.initials: RF
authors.lastname: Wilson
authors.forename: L E
authors.initials: LE
authors.lastname: Binkley
authors.forename: F M
authors.initials: FM
authors.lastname: Sabo
authors.forename: J A
authors.initials: JA
authors.lastname: Wilson
authors.forename: M M
authors.initials: MM
authors.lastname: Munkarah
authors.forename: S A
authors.initials: SA
authors.lastname: Dulchavsky
authors.forename: L N
authors.initials: LN
authors.lastname: Diebel
mesh_terms: D001784:Blood Gas Analysis; D001798:Blood Proteins / Q000032:analysis; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002118:Calcium / Q000097:blood; D004573:Electrolytes / Q000097:blood; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008274:Magnesium / Q000097:blood; D008824:Michigan / Q000453:epidemiology; D015996:Survival Rate; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000453:epidemiology* / Q000209:etiology
chemical_list: D001798:Blood Proteins; D004573:Electrolytes; D008274:Magnesium; D002118:Calcium