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Electrolyte and acid-base changes with massive blood transfusions.

R F Wilson1, L E Binkley, F M Sabo

  • 1Department of Surgery, Detroit Receiving Hospital, Michigan.

The American Surgeon
|September 11, 1992
PubMed
Summary
This summary is machine-generated.

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Massive transfusions can cause dangerous electrolyte and acid-base shifts, including acidosis and hypocalcemia. Close monitoring of pH, potassium, and calcium is crucial for patient survival during massive blood transfusions.

Area of Science:

  • Critical Care Medicine
  • Transfusion Medicine
  • Clinical Chemistry

Background:

  • Massive transfusions (≥10 units/24h) are common in trauma and surgery.
  • Electrolyte and acid-base disturbances are known complications.
  • The impact of these changes on patient outcomes requires further investigation.

Purpose of the Study:

  • To analyze electrolyte and acid-base changes in patients receiving massive transfusions.
  • To identify correlations between these changes and patient mortality.
  • To establish critical monitoring parameters for massive transfusion protocols.

Main Methods:

  • Retrospective review of 471 patients undergoing massive transfusions.
  • Analysis of serum electrolytes (potassium, ionized calcium) and acid-base parameters (pH, HCO3, PCO2).

Related Experiment Videos

  • Comparison of parameters between survivors and non-survivors.

    • Main Results:

    • Survivors had less severe acidosis (pH 7.23 vs 7.11) and higher bicarbonate (HCO3) levels.
    • 83% of deaths were associated with combined metabolic and respiratory acidosis.
    • 94% of patients had hypocalcemia, with severe hypocalcemia linked to a 71% mortality rate.
    • Hyperkalemia was more prevalent in patients dying within 48 hours.

    Conclusions:

    • Massive transfusions significantly alter electrolyte and acid-base balance.
    • Hypocalcemia and severe acidosis are strong predictors of mortality.
    • Continuous monitoring of pH, PCO2, potassium, and ionized calcium is essential.
    • Judicious correction of volume and pH, avoiding overcorrection, is critical.