title: Ionization and hemodynamic effects of calcium chloride and calcium gluconate in the absence of hepatic function.
abstract: Serial serum ionized calcium concentrations were measured before and after administration of either calcium chloride or calcium gluconate during the anhepatic stage of liver transplantation in 15 patients to determine the release of ionized calcium in the absence of hepatic function. When hypocalcemia (Ca++ less than 0.8 mM) occurred during the anhepatic stage, patients were randomly assigned to treatment with chemically equivalent doses of either calcium chloride (10 mg/kg, n = 8) or calcium gluconate (30 mg/kg, n = 7). Serum concentrations of ionized calcium and citrate, hematocrit, arterial blood gas tensions, acid-base state, and hemodynamic profiles were determined before and up to 10 min after calcium therapy. In both groups of patients initial similar and rapid increases in Ca++ (0.98 +/- 0.14 mM in the calcium chloride group and 1.05 +/- 0.10 mM in the calcium gluconate group) were followed by gradual decreases over the next 10 min. Measured hemodynamic values were similar in the two groups, and neither group showed improvement in cardiovascular function after calcium therapy, possibly because of the decrease in preload that occurred during the anhepatic stage. Equally rapid increases in Ca++ after administration of calcium chloride and gluconate in the anhepatic state suggest that calcium gluconate does not require hepatic metabolism for the release of Ca++ and is as effective as calcium chloride in treating ionic hypocalcemia in the absence of hepatic function.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Presbyterian-University Hospital, Pennsylvania 15213.
authors.forename: T J
authors.initials: TJ
authors.lastname: Martin
authors.forename: Y
authors.initials: Y
authors.lastname: Kang
authors.forename: K M
authors.initials: KM
authors.lastname: Robertson
authors.forename: M A
authors.initials: MA
authors.lastname: Virji
authors.forename: J M
authors.initials: JM
authors.lastname: Marquez
mesh_terms: D000328:Adult; D002118:Calcium / Q000097:blood; D002122:Calcium Chloride / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002125:Calcium Gluconate / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005942:Gluconates / Q000493:pharmacokinetics*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D005942:Gluconates; D002122:Calcium Chloride; D002125:Calcium Gluconate; D002118:Calcium