Refractory Hypotension Associated With Hypocalcemia and Renal Disease

Ghent, Shawn; Judson, Marc A.; Rosansky, Steven J.

doi:10.1016/s0272-6386(12)81007-9

Cited by 15 publications

(14 citation statements)

References 4 publications

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“…Hypocalcemia also causes QT interval prolongation, associated with after‐repolarizations and triggered dysrhythmias . As in our patient, hypocalcemia‐induced hypotension and myocardial dysfunction are rapidly reversible by calcium repletion …”

Section: Discussionsupporting

confidence: 69%

“…Intradialytic hypotension is the most common hemodialysis complication, occurring in 20% to 30% of treatments . Hypocalcemia may cause hypotension when rapidly induced by ethylenediaminetetraacetic acid (EDTA), citrated blood transfusion, and citrate anticoagulation during apheresis . We describe a case of intradialytic hypotension caused by severe acute hypocalcemia due to inadvertent use of a zero calcium liquid acid dialysate concentrate.…”

Section: Introductionmentioning

confidence: 99%

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Dialysate‐induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations

Thurlow

Yuan

2016

Hemodialysis International

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Intradialytic hypotension is the most common complication associated with hemodialysis. We describe a case of severe intradialytic hypotension during routine chronic dialysis, the presenting symptom of hypocalcemia due to a procedural error involving a zero calcium liquid acid dialysate concentrate. Although human factors were the root cause of this event, we discuss physical and procedural controls that may help to minimize the risk of human error. Citrate anticoagulation for renal replacement therapy is increasingly used, particularly in acute kidney injury. Thus, zero calcium liquid acid dialysate is more likely to be stocked by dialysis units that serve both inpatients and outpatients. Providers in such units must maintain the utmost vigilance for human error involving these concentrates, as it is likely that the reported literature does not accurately reflect the frequency of such adverse events occurring during dialysis. Structured and universal reporting of errors to allow systematic analysis of hemodialysis device related hazards would allow identification of engineering controls that could prevent such potentially catastrophic clinical errors.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Dialysate‐induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations

Thurlow

Yuan

2016

Hemodialysis International

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“…Ionized calcium is the biologically active form. Ionized hypocalcemia may lead to decreased cardiac contractility and hypotension [39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study

Yu¹,

Peng²,

Cen³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Continuous renal replacement therapy (CRRT) is a treatment for acute kidney injury (AKI) patients. It has become a controversy about whether patients with liver dysfunction should perform CRRT with regional citrate anticoagulation (RCA). Methods: This retrospective observational study enrolled 145 AKI patients (275 CRRT sessions) who received CRRT with RCA and had no history of chronic liver disease. Circuit survival time, blood pressure, trans-membrane pressure (TMP), acid-base and electrolyte status were recorded and analyzed. The severity of liver dysfunction was determined by total bilirubin (TBil) and international normalized ratio (INR), while the accumulation degree of citrates was quantified by total/ ionized calcium (tCa/iCa) raito. Results: Our results showed that there was no correlation of tCa/iCa ratio with TBil or INR. And tCa/iCa ratio was not related to the disturbances of pH, lactates, sodium, magnesium, blood pressure or TMP despite that high tCa/iCa ratios might be related to the decrease of circuit survival time. TBil did not correlate with the above indexes, except for lactates levels. INR did not correlate with the above indexes except for lactates levels and blood pressure. In addition, neither was TBil, INR, nor tCa/iCa ratio, related with fatal outcomes (22.76% of the patients). Conclusion: The present study demonstrated that, with proper monitoring and adjustment of citrates and calcium infusion, applying RCA in CRRT is reasonably safe for AKI patients with acute liver dysfunction, as long as circuit time stays below roughly 50 hours.

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“…It appears probable that these patients could have tolerance to such complications in long‐standing cases in which plasma calcium levels decrease slowly over years or decades. Thus, in many cases of hypocalcemic heart failure, 2–6 including ours, symptoms of neuromuscular irritability of hypocalcemia, such as tingling and tetany, were absent. Apart from the patient's mild disorientation, he did not have neurologic complications.…”

Section: Discussionmentioning

confidence: 62%

“…Unfortunately, measurement of serum calcium is sometimes initially overlooked upon presentation of heart failure. Traditional treatment with diuretics and digoxin has not effectively improved the cardiac condition when hypocalcemia later proved to be the underlying cause 2,6,10 . Indeed, in one report, 6 hypocalcemic heart failure was treated with calcium replenishment alone.…”

Section: Discussionmentioning

confidence: 99%

Severe Hypocalcemia: A Rare Cause of Reversible Heart Failure

Mikhail

El-Bialy

Grosser

2001

Congestive Heart Failure

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Despite the crucial role of calcium in myocardial contractility, hypocalcemia has been rarely reported as a cause of heart failure. In this article, the authors describe a case of severe hypocalcemia caused by idiopathic hypoparathyroidism and worsened by concomitant hypomagnesemia. The patient presented with congestive heart failure that improved dramatically with amelioration of plasma calcium levels. This case and other similar cases in the literature revealed that hypocalcemic heart failure is reversible. Measurement of plasma calcium should be included in the initial work-up of all patients with heart failure, and plasma magnesium must also be checked and corrected if hypocalcemia is demonstrated. (c)2001 CHF, Inc.

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Refractory Hypotension Associated With Hypocalcemia and Renal Disease

Cited by 15 publications

References 4 publications

Dialysate‐induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations

Dialysate‐induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations

Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study

Severe Hypocalcemia: A Rare Cause of Reversible Heart Failure

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