Ionized hypocalcemia after fresh frozen plasma administration to thermally injured children: effects of infusion rate, duration, and treatment with calcium chloride.
A number of cardiac arrests and severe hypotensive episodes have been witnessed associated with the intravenous infusion of fresh frozen plasma (FFP). To clarify the possible role of hypocalcemia, 28 thermally injured anesthetized pediatric patients with massive blood loss were studied to examine the cardiovascular responses (mean arterial pressure [MAP], heart rate, ECG) to 49 infusions of FFP. Rapid, statistically significant reductions in ionized calcium ([Ca2+]) followed each of four rates (1.0, 1.5, 2.0, and 2.5 ml.kg-1.min-1 for 5 minutes) of FFP infusion (P less than 0.0001). The slowest rate resulted in significantly less reduction in [Ca2+] than did the higher infusion rates (P less than 0.002). In five children MAP decreased greater than or equal to 20% below baseline levels, but this was not correlated with rate of FFP administration or decrease in [Ca2+]. The decreases in [Ca2+] and MAP were inversely related to age and unrelated to anesthetic technique. Changes in the Q-oTc interval were not related to [Ca2+]. Adverse cardiovascular responses and reduced [Ca2+] were not significantly different between 5- and 10-minute FFP infusions. Fewer fluctuations in MAP occurred when calcium chloride (CaCl2) was administered; the least fluctuation in [Ca2+] occurred when CaCl2 was administered during the plasma infusion. It is concluded that in thermally injured children 1-17 years old: 1) Rapid infusions of FFP produce sudden but evanescent decreases in [Ca2+]; more rapid infusions result in greater reductions in [Ca2+]. 2) There is no correlation between [Ca2+] and systemic hypotension. 3) Clinically important decreases in MAP occasionally accompany the rapid infusion of FFP.(ABSTRACT TRUNCATED AT 250 WORDS)
Coté
C J
CJ
Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
Drop
L J
LJ
Hoaglin
D C
DC
Daniels
A L
AL
Young
E T
ET
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D000758:Anesthesia / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D002056:Burns / Q000378:metabolism / Q000628:therapy*; D002118:Calcium / Q000378:metabolism*; D002122:Calcium Chloride / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002951:Citrates / Q000378:metabolism; D002986:Clinical Trials as Topic; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology*; D007223:Infant; D007262:Infusions, Intravenous; D010949:Plasma; D011446:Prospective Studies; D011897:Random Allocation; D013997:Time Factors
D002951:Citrates; D002122:Calcium Chloride; D002118:Calcium