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Effect of calcium infusion on heart function
Insights
Calcium chloride infusion in hypocalcemic patients did not improve heart function. Cardiovascular parameters temporarily rose then fell, suggesting caution is needed, especially for patients with left heart issues.
Area of Science:
- Cardiology
- Critical Care Medicine
- Electrolyte Balance
Background:
- Hypocalcemia can impair cardiac function in critically ill patients.
- The cardiovascular effects of calcium supplementation in this population require clarification.
Purpose of the Study:
- To investigate the impact of calcium chloride infusion on cardiovascular parameters in critically ill hypocalcemic patients.
Main Methods:
- Ten hypocalcemic patients received a 30-minute infusion of 1 gm calcium chloride.
- Measurements included total calcium, ionized calcium, blood pressure, cardiac output, and heart work before, during, and after infusion.
Main Results:
- Calcium chloride infusion temporarily increased ionized calcium levels.
- Cardiac output and left ventricular stroke work showed a transient rise, followed by a decline below baseline levels.
- Systemic and pulmonary resistance did not show significant sustained changes.
Conclusions:
- Calcium infusion for hypocalcemia does not offer significant cardiovascular benefits in critically ill patients.
- Its use should be approached with caution, particularly in patients with compromised left heart function, necessitating close monitoring.
Abstract:
The effects of calcium on heart function were studied in ten critically ill hypocalcemic patients (Ca++ = 1.93 +/- 0.08 mEq/L SD). Total calcium (TC), Ca++, blood pressure (MAP), venous pressure (CVP), pulmonary wedge pressure (PWP), cardiac output (CO), heart work (LVSW), systemic resistance (SPR), and pulmonary resistance (PVR) were measured before, during (15 and 30 minutes), and after (60 minutes) a 30-minute infusion of 1 gm CaCl2 (13.7 mEq). Calcium chloride infusion increased Ca++ significantly at 15 and 30 minutes (2.2 +/- 0.25 mEq/L) and remained elevated at 60 minutes (2.12 +/- 0.24). Cardiac output and LVSW rose at 15 minutes (9.4 leads to 10.6 L/min; 98 leads to 115 gm-m) but fell to below preinfusion levels by 60 minutes (8.9 +/- 2.0 L/min and 92 +/- 30 gm-m, respectively). These data show that calcium infusion for hypocalcemia does not provide meaningful improvement in cardiovascular function and is best avoided unless left heart function is closely monitored.