Calcium supplementation of saline-based colloids does not produce equivalent coagulation profiles to similarly balanced salt preparations.
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.
Roche
Anthony M
AM
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. tony.roche@duke.edu
James
Michael F M
MF
Bennett-Guerrero
Elliott
E
Mythen
Michael G
MG
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
D000418:Albumins; D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride; D002122:Calcium Chloride