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Canadian Journal of Anesthesia, Vol 27, 458-463, Copyright © 1980 by Canadian Anesthesiologists' Society

Continuous Monitoring of Serum Ionized Calcium in the Dog During Sodium Citrate Infusion Using an Extracorporeal Blood Shunt

JOHN K. HAYES 1, RICHARD A. BREMER 1, K. C. WONG 1, WILLIAM S. JORDAN 1, and DWAYNE R. WESTENSKOW 1

1 Department of Anesthesiology, University of Utah College of Medicine, 50 North Medical Drive, Salt Lake City, Utah 84132, U.S.A.

The effect of sodium citrate infusion on the cardiovascular system was studied in six mongrel dogs. Serum ionized calcium concentration ([Ca++]) was monitored continuously using a Radiometer calcium selective electrode (Selectrode) in an extracorporeal blood shunt. Twelve, 24 and 48 mg·kg-1 of sodium citrate were infused into each animal. These concentrations correspond to the maximum amount of citrate that would be received by a 70 kg man given 0.5, 1.0 and 2.0 units of CPD treated blood. Each of the solutions were infused over a 5-minute period to duplicate a fairly rapid rate of blood transfusion in man. The decrease in [Ca++] along with blood pH and cardiovascular parameters were measured to determine the relationship between [Ca++] and cardiovascular dynamics. The following parameters were analyzed: mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), peripheral vascular resistance (PVR), cardiac output (CO), pulmonary arterial pressure (PAP), pulmonary wedge pressure (PWP), [Ca++], total calcium (Ca) and pH. Statistically significant decreases occurred in SV, MAP and CO. Decreases in serum [Ca++] of 7.7 ± 1.0 per cent, 15.4 ± 1.9 per cent and 33.6 ± 3.6 per cent were observed for the 12, 24 and 48 mg·kg-1 sodium citrate solution infusions, respectively. The recovery time for the [Ca++] to reach pre-infusion levels was 7.3 ± 0.4 minutes, 14.3 ± 1.6 minutes and 21.3 ± 1.4 minutes, respectively, for the three solutions.

Our data show that significant degrees of hypocalcaemia and myocardial depression may accompany the infustion of citrate solutions. The degree of myocardial depression that we observed in healthy, unstressed animals was not a threat to life with the quantities of citrate we infused. However, in cases requiring larger blood transfusions, such as haemorrhagic shock or RH incompatibility, the cardiovascular system will be compromised considerably at the outset and further myocardial depression secondary to hypocalcaemia may result. The extracorporeal blood shunt proved to be a very simple, efficient and illustrative way of monitoring the level of [Ca++] continuously in the circulatory system during citrate infusion.

Note:

Supported by a grant from The Utah Heart Association.






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Copyright © 1980 by the Canadian Anesthesiologists' Society.