Hypocalcemia in the ICU is one of the more confusing electrolyte abnormalities, because it's frankly unclear exactly what to do with it. Most patients in ICU are hypocalcemic, but there is little evidence that trying to “replete” hypocalcemia back to euboxia is beneficial (or even feasible). Of course, there are some patients who have severe hypocalcemia and definitely benefit from calcium administration (e.g. massive transfusion). Also, understanding the causes and addressing them is always advisable.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Great post as always. I am missing a more detailed section on Citrate dialysis and citrate accumulation. Maybe in a future update…
Yes, please! At my workplace (surgical ICU) this is definitely the No 1 cause auf low calcium.
Great article. I would like to add that while validation studies have shown that albumin-corrected calcium doesn’t work well, several newer calcium-correction equations–some with apps or online calculators–have been published and validated (though not yet tested in citrate setting).
REF:
jlpm.amegroups.com/article/view/6875