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The beneficial role of calcium supplementation during resuscitation from shock
Insights
Calcium supplementation enhances resuscitation from hemorrhagic shock, especially with an intact parathyroid axis. Avoiding calcium or using channel blockers impaired recovery and increased mortality in dogs.
Area of Science:
- Physiology
- Resuscitation Medicine
- Calcium Metabolism
Background:
- The role of calcium in hemorrhagic shock resuscitation is debated.
- Previous studies have yielded conflicting results regarding calcium's impact.
Purpose of the Study:
- To compare calcium supplementation (Ca-S), avoidance (No-Ca), and calcium channel blockade (Ca-B) during hemorrhagic shock resuscitation.
- To investigate the influence of the calcium-parathyroid axis on resuscitation outcomes.
Main Methods:
- Forty splenectomized dogs underwent controlled hemorrhagic shock.
- Dogs were resuscitated with various fluid and blood therapies.
- Three regimens (Ca-S, No-Ca, Ca-B) were administered, with and without parathyroidectomy (P).
- Hemodynamic parameters (MAP, CFP, CO, SVR, LVW) and outcomes were monitored.
Main Results:
- Post-resuscitation calcium levels were significantly lower in No-Ca and Ca-B groups compared to Ca-S.
- No-Ca and Ca-B groups exhibited reduced MAP, CO, and LVW, irrespective of parathyroid status.
- Lower central filling pressures (CFP) were observed in Ca-S groups.
- Increased mortality was noted in No-Ca/P and Ca-B/P groups.
Conclusions:
- Calcium supplementation appears beneficial for hemorrhagic shock resuscitation.
- An intact calcium-parathyroid axis, combined with calcium supplementation, optimizes resuscitation efforts.
- Calcium channel blockade may be detrimental during resuscitation.
Abstract:
The role of calcium (Ca) in resuscitation from hemorrhagic shock is controversial and in the present report three regimens were compared: supplementation (Ca-S), avoidance (No-Ca), and Ca channel blockade (Ca-B). This was studied in 40 splenectomized dogs subjected to reservoir shock (MAP 60 torr/90 min, then 40 torr/30 min) and treated with: a) 20 ml/kg balanced electrolyte solution (BES); b) shed blood; c) 30 ml/kg BES; and d) 250 ml autologous bank blood. Three groups of six dogs received Ca-S (0.5 mEq/kg), No-Ca, or Ca-B (verapamil 0.15 mg/kg) in BES. Postoperative therapy of 50 ml/kg/d BES with Ca-S, No-Ca, or Ca-B was given for 3 days. The effects of parathyroidectomy (P) via wide thyroidectomy in 22 dogs treated with calphosan (20 ml/d) and L-thyroxin (0.02 mg/kg) preceding shock was also studied as above: Ca-S/P, No-Ca/P, and Ca-B/P; four sham dogs had anesthesia but no shock (Anes/P). Studies done before, during, and after shock and on day three included systemic pressures (MAP), central pressures (CFP), cardiac output (CO), resistance (SVR), heart work (LVW), and outcome. Post-resuscitation Ca was significantly less in all groups (1.6-3.7 mg%) compared to Ca-S (4.8 mg%). Compared to Ca-S dogs, the post-resuscitation studies in the No-Ca and Ca-B dogs showed lower MAP, CO, and LVW in both intact and hypoparathyroid animals. Post-resuscitation CFP was also lower in the Ca-S and Ca-S/P dogs compared to the other euparathyroid and hypoparathyroid dogs. Death after the initiation of resuscitation occurred in two No-Ca/P and three Ca-B/P dogs. These data suggest that calcium supplementation plus an intact calcium-parathyroid axis enhance the resuscitation effort.