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Optimization of infusional calcium gluconate for prevention of hypocalcemic reactions during therapeutic plasma exchange
Author(s) -
Zhao Yong,
Garrity Danielle,
Graves Molly,
Linden Jeanne,
St. Pierre Patricia,
Ducharme Paula,
Greene Mindy,
Vauthrin Michelle,
Weinstein Robert
Publication year - 2019
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21742
Subject(s) - medicine , therapeutic plasma exchange , calcium , plasma volume , plasma concentration , calcium metabolism , endocrinology , anesthesia , pharmacology
We sought to optimize direct intravenous infusion of calcium gluconate (CaGlu) for maintaining plasma ionized calcium concentration ([Ca 2+ ]) and preventing hypocalcemic reactions during 34 consecutive 1‐volume therapeutic plasma exchanges (TPEs) in eight patients. CaGlu, 2 g in 50 mL of 0.9% NaCl, was prepared by our hospital pharmacy and infused at either 1.0 or 1.6 g/h during alternate TPE. Plasma [Ca 2+ ] was monitored at intervals of 20 to 30 minutes. At 1 g/h of CaGlu, plasma [Ca 2+ ] fell by 8.35% after 40 to 50 minutes and then plateaued. At 1.6 g/h of CaGlu, plasma [Ca 2+ ] fell by 6% after 20 to 30 minutes and then plateaued. The difference at 40 to 50 minutes was significant ( P = .015). Hypocalcemic reactions were noted in three patients during 5 of 17 TPE at 1.0 g/h (all after 40 to 60 minutes) but 0 of 17 TPE at 1.6 g/h ( P = .044). CaGlu at 1.6 g/h stabilized plasma [Ca 2+ ] and appears to prevent hypocalcemic reactions during TPE.