JOURtrolyte and acid-base changes with massive blood transfusions.

TitleJOURtrolyte and acid-base changes with massive blood transfusions.
Publication TypeJournal Article
Year of Publication1992
AuthorsWilson RF, Binkley LE, Sabo, Jr FM, Wilson JA, Munkarah MM, Dulchavsky SA, Diebel LN
JournalThe American surgeon//Am Surg
Pagination535 - 5
Date Published1992
ISBN Number0003-1348
Other Numbers43e, 0370522
Keywords*Blood Transfusion/ae [Adverse Effects], *Hemorrhage/th [Therapy], *Water-Electrolyte Imbalance/ep [Epidemiology], Blood Gas Analysis, Blood Proteins/an [Analysis], Blood Transfusion/sn [Statistics & Numerical Data], Calcium/bl [Blood], Hemorrhage/et [Etiology], Hospitals, University, Humans, Incidence, JOURtrolytes/bl [Blood], Magnesium/bl [Blood], Michigan/ep [Epidemiology], Survival Rate, Treatment Outcome, Water-Electrolyte Imbalance/bl [Blood], Water-Electrolyte Imbalance/et [Etiology]

The case records of 471 patients with massive transfusions of ten or more units of bank blood within 24 hours were reviewed to analyze the electrolyte and acid-base changes. The patients who lived had a less severe acidosis (7.23 +/- 0.15 vs 7.11 +/- 0.17) and the HCO3 was higher (19.8 +/- 15.2 vs 13.4 +/- 6.8) (P less than 0.001). The mean anion gap, despite the low HCO3, was 11.8 +/- 7.8 mEq/L. A combined metabolic and respiratory acidosis, often following bicarbonate therapy, was fetal in 83 per cent (39/47). Serum potassium values (K) were high in 22 per cent and low in 18 per cent of patients. If potassium levels were "corrected" by subtracting 0.5 mEq/L for each 0.1 pH of metabolic acidosis, only 5 per cent of patients were hyperkalemic. Patients dying within 48 hours of the massive transfusions had higher potassium levels (4.9 +/- 1.1 vs 4.4 +/- 0.9; P less than 0.001). Ionized calcium levels (Ca++) were less than normal (1.13-1.32 mmol/L) in 94 per cent of patients and were very low (less than 0.70 mmol/L) in 46 per cent (108/234). The mortality rate with severe ionic hypocalcemia was 71 per cent (vs 40% in patients with more normal values); P less than 0.0001. pH, PCO2, K, and Ca++ must be followed closely with massive transfusions. Rapid correction of volume and pH, without overcorrection, is essential.

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