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[Blood calcium levels in heart defects after surgery with extracorporeal circulation]
Insights
Post-heart surgery patients experience calcium level fluctuations due to citrate anticoagulation. Repeated calcium chloride injections help stabilize these levels within 5 days.
Area of Science:
- Cardiovascular Surgery
- Clinical Chemistry
- Critical Care Medicine
Context:
- Patients undergoing extracorporeal circulation for heart disease surgery.
- Calcium and protein metabolism post-cardiac surgery.
- Effects of citrate anticoagulation during cardiopulmonary bypass.
Purpose:
- To investigate calcium and protein levels in the early postoperative period after heart surgery.
- To assess the impact of cardiopulmonary bypass on calcium balance.
- To determine effective calcium repletion strategies.
Summary:
- Calcium levels, including dialyzable fractions, were monitored in 50 post-heart surgery patients.
- Elevated calcium on day 1 post-op is linked to calcium administration for citrate neutralization.
- Significant calcium balance impairment persists for 5 days, with repeated CaCl2 injections showing efficacy.
Impact:
- Highlights the transient but significant impact of cardiopulmonary bypass and blood transfusions on calcium homeostasis.
- Identifies optimal calcium repletion protocols for managing postoperative hypocalcemia.
- Informs clinical practice for managing electrolyte balance in cardiac surgery patients.
Abstract:
The total content of calcium and protein was studied in 50 patients during the initial 5 days after surgery for their congenital or acquired heart diseases conducted under extracorporeal circulation; in half of them the content of the dialysing fraction of total calcium and plasma albumins were also examined. The study has demonstrated that during the 1st postoperative day the content of the total and dialysing calcium is elevated which is due to the administration of calcium for the neutralization of citrate during blood transfusions. The greatest fluctuations of these values (both decreases and increases) were observed when the heart-lung machine was primed with blood containing 18.2--23mEg Ca++ per 1 1 of citrate blood. Within the early 5 postoperative days no restoration of the impaired calcium balance is observed in these patients, while the blood content of calcium is returning to the preoperative level. The blood content of calcium was studied after repeated injections of various doses of calcium. The most rational method proved to consist in repeated injections of 5ml of 10% CaCl2 solution every 30 min--1 hour which resulted in a moderate elevation of the blood content of the total and dialysing calcium.