title: Calcium supplementation of saline-based colloids does not produce equivalent coagulation profiles to similarly balanced salt preparations.
abstract: OBJECTIVE
  The primary objective of this study was to test the hypothesis that calcium alone does not account for the observed coagulation differences between saline-based and balanced electrolyte IV fluid preparations.
  
  
  METHODS
  Controlled, nonblinded, in vitro observational study.
  
  
  METHODS
  University-based anesthesia research laboratory.
  
  
  METHODS
  Ten healthy volunteers.
  
  
  METHODS
  The volunteers donated fresh blood for in vitro 40% and 60% dilution with 6 intravenous fluid preparations (lactated Ringer's solution, human albumin solution, and 4 hydroxyethyl starch preparations). All saline-based fluids were supplemented with calcium chloride to obtain ionized concentrations >or=1.0 mmol/L.
  
  
  RESULTS
  After dilution of the fresh blood with the study fluids, samples were analyzed by using the Thrombelastograph. Three colloid preparations produced minimal coagulation derangement, even at 60% dilution (human albumin solution, tetrastarch in saline, and pentastarch in balanced electrolyte solution), whereas pentastarch in saline and hetastarch in balanced electrolyte produced a mildly hypocoagulable state at 60% dilution.
  
  
  CONCLUSIONS
  The different coagulation profiles between the 2 pentastarch preparations, as well as similar profiles of pentastarch in saline and hetastarch in balanced electrolyte solution, suggest that calcium is not solely responsible for previously observed effects.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. tony.roche@duke.edu
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Roche
authors.forename: Michael F M
authors.initials: MF
authors.lastname: James
authors.forename: Elliott
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: Michael G
authors.initials: MG
authors.lastname: Mythen
mesh_terms: D000418:Albumins / Q000494:pharmacology; D001777:Blood Coagulation / Q000187:drug effects*; D002122:Calcium Chloride / Q000494:pharmacology*; D003102:Colloids / Q000737:chemistry / Q000494:pharmacology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D007552:Isotonic Solutions / Q000494:pharmacology; D012016:Reference Values; D000077325:Ringer's Lactate; D012965:Sodium Chloride / Q000737:chemistry / Q000494:pharmacology*; D013916:Thrombelastography / Q000379:methods
chemical_list: D000418:Albumins; D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride; D002122:Calcium Chloride