A trauma patient may develop hypocalcemia, especially after massive transfusion. This can worsen outcomes.
Causes of hypocalcemia:
(1) trauma-related hypocalcemia, associated with calcium loss if bleeding
(2) transfusion-related hypocalcemia, due to citrate in blood products
Ionized calcium reflects calcium status better than the total calcium. An ionized calcium < 1.12 mmol/L indicates hypocalcemia, and a value < 0.90 mmol/L indicates severe hypocalcemia.
Hypocalcemia may exacerbate and be exacerbated by the "lethal triad":
(1) hypothermia
(2) acidosis
(3) coagulopathy
Ditzel et al referred the triad plus hypocalcemia as a "lethal diamond".
Administration of intravenous calcium chloride can reduce the hypocalcemia.
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