Optimization of infusional calcium gluconate for prevention of hypocalcemic reactions during therapeutic plasma exchange. Issue 6 (10th August 2019)

• Record Type: Journal Article
• Authors: Zhao, Yong; Garrity, Danielle; Graves, Molly; Linden, Jeanne; St. Pierre, Patricia; Ducharme, Paula; Greene, Mindy; Vauthrin, Michelle; Weinstein, Robert
• Is Part Of: Journal of clinical apheresis. Volume 34:Issue 6(2019)
• Page Start: 656
• Page End: 660
• Publication Date: 2019-08-10
• Subjects: adverse effects -- apheresis -- ionized calcium -- Optia; Hemapheresis -- Periodicals; Blood -- Transfusion -- Periodicals; Blood -- Transfusion, Autologous -- Periodicals; Cell separation -- Periodicals; Leukapheresis -- Periodicals; Plasmapheresis -- Periodicals; 615.39
• DOI: 10.1002/jca.21742
• Languages: English
• ISSNs: 0733-2459

Abstract

Abstract: 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.