Early hypocalcemia in severe trauma.
OBJECTIVE
We tested the hypothesis that colloid-induced hemodilution can induce hypocalcemia in the early phase of severe trauma resuscitation and tried to assess other potential causative factors of that hypocalcemia.


METHODS
Prospective cohort.


METHODS
Level I academic trauma center.


METHODS
Consecutive severe trauma patients (n = 212, mean Injury Severity Score 34) resuscitated in the prehospital phase without any blood transfusion.


METHODS
At admission, ionized calcium (corrected to an arterial pH = 7.40) was measured.


RESULTS
Hypocalcemia was defined as a value <1.15 mmol/L and severe hypocalcemia as a value <0.9 mmol/L. A normal ionized calcium concentration was observed in 56 (26%) patients, a mild ionized hypocalcemia (1.05 +/- 0.06 mmol/L) in 135 (64%) patients, and a severe ionized hypocalcemia (0.77 +/- 0.10 mmol/L) in 21 (10%) patients. There were significant correlations between ionized calcium concentration with the amount of infused colloid (R = .658, p < .001) and arterial pH (R = .760, p < 0.001) but not with the amount of infused crystalloid (R = .007, not significant). Despite taking into account hemodilution, arterial pH, binding of calcium to lactates, and colloids, some patients had marked differences (>15%) between calculated and observed ionized calcium, and these patients had more severe trauma and more frequently had acidosis and/or prehospital cardiac arrest. Using the TRISS methodology, survival was not significantly different from that expected in this trauma population.


CONCLUSIONS
Hypocalcemia frequently occurs on arrival at the hospital in severe trauma patients, and colloid-induced hemodilution and severe shock and/or ischemia-reperfusion appear to be important causative factors.
Vivien
Benoît
B
Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Paris, France.
Langeron
Olivier
O
Morell
Eric
E
Devilliers
Catherine
C
Carli
Pierre A
PA
Coriat
Pierre
P
Riou
Bruno
B
D000138:Acidosis / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D005260:Female; D006438:Hemodilution / Q000009:adverse effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006996:Hypocalcemia / Q000209:etiology*; D007552:Isotonic Solutions; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011446:Prospective Studies; D012769:Shock / Q000150:complications; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000401:mortality
D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D007773:Lactates; D010952:Plasma Substitutes; D002118:Calcium