Do Early Ionized Calcium Levels Really Matter in Trauma Patients?

Cherry, Robert A.; Bradburn, Eric H.; Carney, Daniel E.; Shaffer, Michele L.; Gabbay, Robert A.; Cooney, Robert N.

doi:10.1097/01.ta.0000239516.49799.63

Cited by 63 publications

(79 citation statements)

References 24 publications

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“…Evidence in recent literature suggests that an ionised calcium of <1 significantly increases patient mortality regardless of age and ISS5 and calcium <0.88 increases mortality threefold 10…”

Section: Discussionmentioning

confidence: 99%

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Ionised calcium levels in major trauma patients who received blood in the Emergency Department

et al. 2016

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Section: Discussionmentioning

confidence: 99%

“…Hypocalcaemia is a common finding in critically ill patients 2. Previous studies in trauma have shown that admission hypocalcaemia is associated with hypotension and significantly increased mortality 2 5…”

Section: Introductionmentioning

confidence: 99%

Ionised calcium levels in major trauma patients who received blood in the Emergency Department

et al. 2016

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“…The fall in [Ca 2þ ] o correlates with the severity of the hyperadrenergic state and, in turn, the severity of illness. Ionized hypocalcemia serves as an inhospital marker of survival [1][2][3][4][5][6][7][8]33,34]. Hypoalbuminemia can Fig.…”

Section: Hypocalcemiamentioning

confidence: 99%

“…The extent to which these cation concentrations decline correlates with the severity of injury and, in turn, the degree of neurohormonal activation. Accordingly, fallen serum cation levels are predictive of prognosis in patients with bodily injury of diverse origins [1][2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Stressor States and the Cation Crossroads

Weber¹,

Bhattacharya²,

Newman³

et al. 2010

Journal of the American College of Nutrition

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Neurohormonal activation involving the hypothalamic-pituitary-adrenal axis and adrenergic nervous and renin-angiotensin-aldosterone systems is integral to stressor state-mediated homeostatic responses. The levels of effector hormones, depending upon the degree of stress, orchestrate the concordant appearance of hypokalemia, ionized hypocalcemia and hypomagnesemia, hypozincemia, and hyposelenemia. Seemingly contradictory to homeostatic responses wherein the constancy of extracellular fluid would be preserved, upregulation of cognate-binding proteins promotes coordinated translocation of cations to injured tissues, where they participate in wound healing. Associated catecholamine-mediated intracellular cation shifts regulate the equilibrium between pro-oxidants and antioxidant defenses, a critical determinant of cell survival. These acute and chronic stressor-induced iterations in extracellular and intracellular cations are collectively referred to as the cation crossroads. Intracellular cation shifts, particularly excessive accumulation of Ca2+, converge on mitochondria to induce oxidative stress and raise the opening potential of their inner membrane permeability transition pores (mPTPs). The ensuing loss of cationic homeostasis and adenosine triphosphate (ATP) production, together with osmotic swelling, leads to organellar degeneration and cellular necrosis. The overall impact of iterations in extracellular and intracellular cations and their influence on cardiac redox state, cardiomyocyte survival, and myocardial structure and function are addressed herein.

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“…Hypocalcemia (ionized Ca [iCa] ≤ 1.12 mmol/L) is a relatively common problem in critically ill patients, particularly those with sepsis, acute necrotizing pancreatitis, rhabdomyolysis, trauma, and systemic inflammatory response syndrome [1][2][3][4][5][6][7], and the etiology appears to be multifactorial. Data published to date suggests several different mechanisms may be involved: (i) cytokine-mediated inflammatory response [8], (ii) increased binding to proteins (albumin) [9], (iii) relative parathormone deficiency, or (iv) reduced renal hydroxylase activity [10]; however, simple changes in bone metabolism and renal excretion are not considered viable options.…”

Section: Introductionmentioning

confidence: 99%