In this episode, I’ll discuss critical care scenarios where the monitoring and replacement of calcium are warranted.
Routine efforts to monitor and correct the serum calcium level in critically ill patients only treat the laboratory number; there is no evidence that replacement has an effect on patient morbidity and mortality.
Furthermore, there is some evidence that routine calcium replacement in the ICU may be harmful. A retrospective cohort of patients before and during a calcium gluconate shortage found that calcium administration was significantly associated with an increase in the odds of mortality, respiratory failure, and new-onset shock. Importantly, the authors found that there was a dose-response relationship; as the dose of calcium increased so did the likelihood of an adverse event.
Specific scenarios where monitoring and replacement of calcium are warranted include hypomagnesemia, massive transfusion (due to the citrate anticoagulants in transfused blood which chelate calcium), parathyroid disease, and drug effect (such as from cisplatin).
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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.