Life-threatening pulmonary hypertension and right ventricular failure complicating calcium and phosphate replacement in the intensive care unit.
A 43-year-old man developed septic shock and acute lung injury after surgery to drain an ischiorectal abscess. In the intensive care unit he initially improved but developed severe hypoxaemia, right ventricular failure and pulmonary hypertension 90 min after receiving intravenous calcium gluconate and potassium phosphate, best explained by the formation of a calcium-phosphate precipitant that resulted in aggregate anaphylaxis. His rapid deterioration and lack of response to conventional therapies necessitated support with extracorporeal membrane oxygenation that was life saving. This adverse event has altered local practice regarding calcium and phosphate replacement and has implications for all intensive care units.
Felton
T W
TW
Intensive Therapy Unit, Royal North Shore Hospital, St. Leonards, Sydney, Australia. timothyfelton@doctors.org.uk
McCormick
B A
BA
Finfer
S R
SR
Fisher
M M
MM
D000328:Adult; D002125:Calcium Gluconate / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods; D004347:Drug Interactions; D015199:Extracorporeal Membrane Oxygenation; D006333:Heart Failure / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D010710:Phosphates / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy; D017680:Potassium Compounds / Q000009:adverse effects*; D018497:Ventricular Dysfunction, Right / Q000139:chemically induced* / Q000628:therapy
D010710:Phosphates; D017680:Potassium Compounds; C013216:potassium phosphate; D002125:Calcium Gluconate