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Changes in ionized calcium and other plasma constituents associated with cardiopulmonary bypass
Insights
Cardiopulmonary bypass can cause iatrogenic hypercalcemia due to calcium chloride in prime solutions. This condition may worsen with additional calcium chloride post-surgery, affecting post-operative electrolyte balance.
Area of Science:
- Cardiovascular Surgery
- Clinical Chemistry
- Anesthesiology
Background:
- Cardiopulmonary bypass (CPB) is a critical procedure in cardiac surgery.
- Maintaining electrolyte balance during CPB is essential for patient outcomes.
- The composition of CPB prime solutions can influence perioperative biochemistry.
Purpose of the Study:
- To investigate the effects of CPB on plasma concentrations of calcium fractions, proteins, phosphate, and magnesium.
- To assess the impact of calcium chloride administration in CPB prime solutions on perioperative calcium levels.
- To evaluate the post-operative recovery of these plasma constituents.
Main Methods:
- Plasma samples were collected from 15 cardiac surgery patients at multiple time points: pre-CPB, during CPB, and post-CPB.
- Measurements included various calcium fractions, total protein, phosphate, and magnesium.
- Statistical analysis was performed to compare concentrations before, during, and after CPB.
Main Results:
- CPB significantly increased plasma calcium concentrations, particularly ionized calcium (mean 1.52 mmol/L plasma water 30 min post-CPB).
- Administration of >10 mg/kg calcium chloride within 30 min post-CPB further exacerbated hypercalcemia.
- Other plasma constituents showed dilutional effects from the prime, with magnesium failing to normalize post-operatively.
Conclusions:
- CPB, especially with calcium chloride in the prime, can lead to significant iatrogenic hypercalcemia.
- Post-operative calcium levels require careful monitoring and management.
- Abnormal magnesium levels post-CPB warrant further investigation and clinical attention.
Abstract:
Plasma concentrations of calcium fractions, proteins, phosphate and magnesium were measured before, during and after cardiopulmonary bypass in 15 patients undergoing cardiac surgery. When calcium chloride was added to a pump priming solution which contained little or no blood, the concentrations of all calcium fractions were significantly greater after bypass than before, with a mean ionized calcium concentration of 1.52 mmol litre-1 plasma water, 30 min after completion of bypass. This iatrogenic hypercalcaemia was increased significantly by the administration of more than 10 mg kg-1 calcium chloride in the first 30 min after bypass. Other plasma constituents showed the dilutional effect of the pump prime during bypass and only the magnesium concentration failed to return towards normal values after operation.