Hypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation
Keywords:
Blood transfusion, Hemorrhage, Hypocalcaemia, Hyperkalaemia, Liver transplantation
Abstract
Rapid transfusion of blood products and the presence of ionic changes as Hypocalcaemia and HyperKalaemia are common in liver transplantation. The objective of this paper is to give the reader a clear and practical description of the etiological factors, biochemical mechanisms, diagnosis and treatment of the calcium and potassium plasmatic disorders associated with massive transfusion. The peculiarities that arise in the clinical setting of liver transplant surgery and citrate intoxication are highlighted. A non- systematic review of literature was conducted in MEDLINE, OVID and Cochrane databases. Correct and early anesthetic management of calcium and potassium disorders prevents serious complications in intraoperative bleeding risk surgeries such as liver transplantation.
References
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2. Zuluaga Giraldo M. Management of perioperative bleeding in children. Step by step review. Rev Colomb Anestesiol. 2013;4:50-6.
3. Zuluaga Giraldo M. Pediatric perioperative bleeding - Basic considerations. Rev Colomb Anestesiol. 2013;41:44-9.
4. Lee AC, Reduque LL, Luban NL, Ness PM, Anton B, Heitmiller ES. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion. 2014;54:244-54.
5. Shaz BH, Dente CJ, Harris RS, MacLeod JB, Hillyer CD. Transfusion management of trauma patients. Anesth Analg. 2009;108:1760-8.
6. Donaldson MD, Seaman MJ, Park GR. Massive blood transfusion. Br J Anaesth. 1992;69:621-30.
7. Elmer J, Wilcox SR, Raja AS. Massive transfusion in traumatic shock. J Emerg Med. 2013;44:829-38.
8. Zunini G, Rando K, Martinez-Pelayo FJ, Castillo-Trevizo AL. Massive transfusion and trauma patient management: Pathophysiological approach to treatment. Cir Cir. 2011;79:473-80.
9. Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137:209-20.
10. Denlinger JK, Nahrwold ML, Gibbs PS, Lecky JH. Hypocalcaemia during rapid blood transfusion in anaesthetized man. Br J Anaesth. 1976;48:995-1000.
11. Sulemanji DS, Bloom JD, Dzik WH, Jiang Y. New insights into the effect of rapid transfusion of fresh frozen plasma on ionized calcium. J Clin Anesth. 2012;24:364-9.
12. Huang W, Hei Z. Anesthetic management of adult patients under orthotopic liver transplantation. Zhonghua Yi Xue Za Zhi. 2001;81:737-9.
13. Ho KM, Leonard A. Risk factors and outcome associated with hypomagnesemia in massive transfusion. Transfusion. 2011;51:270-6.
14. Miller RD, editor. Miller' Anesthesia - Fluid and Electrolyte Physiology. 6th ed Phidadelphia: Elsevier; 2005.
15. Forman DT, Lorenzo L. Ionized calcium: Its significance and clinical usefulness. Ann Clin Lab Sci. 1991;21:297-304.
16. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. 2008;35:215-37, v-vi.
17. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ. 2008;336:1298-302.
18. Jawan B, de Villa V, Luk HN, Chen YS, Chiang YC, Wang CC, et al. Ionized calcium changes during living-donor liver transplantation in patients with and without administration of blood-bank products. Transpl Int. 2003;16:510-4.
19. Ho KM, Leonard AD. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39:46-54.
20. Bolan CD, Cecco SA, Wesley RA, Horne M, Yau YY, Remaley AT, et al. Controlled study of citrate effects and response to i.v. calcium administration during allogeneic peripheral blood progenitor cell donation. Transfusion. 2002;42:935-46.
21. Miller RD, editor. Miller' Anesthesia - Transfusion Therapy. 6th ed Philadelphia: Elsevier; 2005.
22. Youngquist ST, Heyming T, Rosborough JP, Niemann JT. Hypocalcemia following resuscitation from cardiac arrest revisited. Resuscitation. 2010;81:117-22.
23. Xia VW, Ghobrial RM, Du B, Chen T, Hu KQ, Hiatt JR, et al. Predictors of hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods during adult liver transplantation. Anesth Analg. 2007;105:780-5.
24. Apsner R, Schwarzenhofer M, Derfler K, Zauner C, Ratheiser K, Kranz A. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr. 1997;109:123-7.
25. Cote CJ, Drop LJ, Daniels AL, Hoaglin DC. Calcium chloride versus calcium gluconate: Comparison of ionization and cardiovascular effects in children and dogs. Anesthesiology. 1987;66:465-70.
26. Heining MP, Band DM, Linton RA. Choice of calcium salt. A comparison of the effects of calcium chloride and gluconate on plasma ionized calcium. Anaesthesia. 1984;39:1079-82.
27. Bull J, Band DM. Calcium and cardiac arrest. Anaesthesia. 1980;35:1066-7.
28. Fong J, Khan A. Hypocalcemia: Updates in diagnosis and management for primary care. Can Fam Physician. 2012;58:158-62.
29. Cote CJ. Depth of halothane anesthesia potentiates citrate-induced ionized hypocalcemia and adverse cardiovascular events in dogs. Anesthesiology. 1987;67:676-80.
30. Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26:377-84.
31. Aronson PS, Giebisch G. Effects of pH on potassium: New explanations for old observations. J Am Soc Nephrol. 2011;22:1981-9.
32. Takaichi K, Takemoto F, Ubara Y, Mori Y. Analysis of factors causing hyperkalemia. Intern Med. 2007;46:823-9.
33. Tsukamoto S, Maruyama K, Nakagawa H, Iwase Y, Kitamura A, Hayashida M. Fatal hyperkalemia due to rapid red cell transfusion in a critically ill patient. J Nippon Med Sch. 2009;76:258-64.
34. Aufhauser Jr DD, Rose T, Levine M, Barnett R, Ochroch EA, Aukburg S, et al. Cardiac arrest associated with reperfusion of the liver during transplantation: Incidence and proposal for a management algorithm. Clin Transplant. 2013;27:185-92.
35. Vannucci A, Burykin A, Krejci V, Peck T, Buchman TG, Kangrga IM. Postreperfusion cardiac arrest and resuscitation during orthotopic liver transplantation: Dynamic visualization and analysis of physiologic recordings. Shock. 2012;37:34-8.
36. Bailey DN, Bove JR. Chemical and hematological changes in stored CPD blood. Transfusion. 1975;15:244-9.
37. Smith HM, Farrow SJ, Ackerman JD, Stubbs JR, Sprung J. Cardiac arrests associated with hyperkalemia during red blood cell transfusion: A case series. Anesth Analg. 2008;106:1062-9.
38. Valeri CR. Blood components in the treatment of acute blood loss: Use of freeze-preserved red cells, platelets, and plasma proteins. Anesth Analg. 1975;54:1-14.
39. Jameson LC, Popic PM, Harms BA. Hyperkalemic death during use of a high-capacity fluid warmer for massive transfusion. Anesthesiology. 1990;73:1050-2.
40. Shi XY, Xu ZD, Xu HT, Jiang JJ, Liu G. Cardiac arrest after graft reperfusion during liver transplantation. Hepatobiliary Pancreat Dis Int. 2006;5:185-9.
41. Huang YR, Gu MN, Deng RJ, Xiao JF, Liang SW, Xu JS, et al. Management of hyperkalemia-induced cardiac arrest in anhepatic stage of orthotopic liver transplantation without venovenous bypass: Report of 3 cases. Di Yi Jun Yi Da Xue Xue Bao. 2004;24, 1210-1210-1,4. Epub 2004//-L1214.
42. Homvises B, Sirivatanauksorn Y, Limsrichamrern S, Pongraweewan O, Sujirattanawimol K, Raksakietisak M. The minimal flush volume for washout of preservation fluid in liver transplantation. Transplant Proc. 2008;40:2123-6.
43. El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol J. 2011;18:233-45.
44. Elliott MJ, Ronksley PE, Clase CM, Ahmed SB, Hemmelgarn BR. Management of patients with acute hyperkalemia. CMAJ. 2010;182:1631-5.
45. Ronco C, editor. Critical Care Nephrology - Renal Replacement Techniques: Descriptions, Mechanisms, Choices and Controversies. 2nd ed Philadelphia: Elsevier; 2009.
46. Dezwaan-McCabe D, Riordan JD, Arensdorf AM, Icardi MS, Dupuy AJ, Rutkowski DT. The stress-regulated transcription factor CHOP promotes hepatic inflammatory gene expression, fibrosis, and oncogenesis. PLoS Genet. 2013;9:e1003937.
47. Chung HS, Cho SJ, Park CS. Effects of liver function on ionized hypocalcaemia following rapid blood transfusion. J Int Med Res. 2012;40:572-82.
48. Urban P, Scheidegger D, Buchmann B, Barth D. Cardiac arrest and blood ionized calcium levels. Ann Intern Med. 1988;109:110-3.
49. Gruber M, Breu A, Frauendorf M, Seyfried T, Hansen E. Washing of banked blood by three different blood salvage devices. Transfusion. 2013;53:1001-9.
50. Niemann JT, Cairns CB. Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: possible culprits for postcountershock arrhythmias? Ann Emerg Med. 1999;34:1-7.
2. Zuluaga Giraldo M. Management of perioperative bleeding in children. Step by step review. Rev Colomb Anestesiol. 2013;4:50-6.
3. Zuluaga Giraldo M. Pediatric perioperative bleeding - Basic considerations. Rev Colomb Anestesiol. 2013;41:44-9.
4. Lee AC, Reduque LL, Luban NL, Ness PM, Anton B, Heitmiller ES. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion. 2014;54:244-54.
5. Shaz BH, Dente CJ, Harris RS, MacLeod JB, Hillyer CD. Transfusion management of trauma patients. Anesth Analg. 2009;108:1760-8.
6. Donaldson MD, Seaman MJ, Park GR. Massive blood transfusion. Br J Anaesth. 1992;69:621-30.
7. Elmer J, Wilcox SR, Raja AS. Massive transfusion in traumatic shock. J Emerg Med. 2013;44:829-38.
8. Zunini G, Rando K, Martinez-Pelayo FJ, Castillo-Trevizo AL. Massive transfusion and trauma patient management: Pathophysiological approach to treatment. Cir Cir. 2011;79:473-80.
9. Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137:209-20.
10. Denlinger JK, Nahrwold ML, Gibbs PS, Lecky JH. Hypocalcaemia during rapid blood transfusion in anaesthetized man. Br J Anaesth. 1976;48:995-1000.
11. Sulemanji DS, Bloom JD, Dzik WH, Jiang Y. New insights into the effect of rapid transfusion of fresh frozen plasma on ionized calcium. J Clin Anesth. 2012;24:364-9.
12. Huang W, Hei Z. Anesthetic management of adult patients under orthotopic liver transplantation. Zhonghua Yi Xue Za Zhi. 2001;81:737-9.
13. Ho KM, Leonard A. Risk factors and outcome associated with hypomagnesemia in massive transfusion. Transfusion. 2011;51:270-6.
14. Miller RD, editor. Miller' Anesthesia - Fluid and Electrolyte Physiology. 6th ed Phidadelphia: Elsevier; 2005.
15. Forman DT, Lorenzo L. Ionized calcium: Its significance and clinical usefulness. Ann Clin Lab Sci. 1991;21:297-304.
16. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. 2008;35:215-37, v-vi.
17. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ. 2008;336:1298-302.
18. Jawan B, de Villa V, Luk HN, Chen YS, Chiang YC, Wang CC, et al. Ionized calcium changes during living-donor liver transplantation in patients with and without administration of blood-bank products. Transpl Int. 2003;16:510-4.
19. Ho KM, Leonard AD. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39:46-54.
20. Bolan CD, Cecco SA, Wesley RA, Horne M, Yau YY, Remaley AT, et al. Controlled study of citrate effects and response to i.v. calcium administration during allogeneic peripheral blood progenitor cell donation. Transfusion. 2002;42:935-46.
21. Miller RD, editor. Miller' Anesthesia - Transfusion Therapy. 6th ed Philadelphia: Elsevier; 2005.
22. Youngquist ST, Heyming T, Rosborough JP, Niemann JT. Hypocalcemia following resuscitation from cardiac arrest revisited. Resuscitation. 2010;81:117-22.
23. Xia VW, Ghobrial RM, Du B, Chen T, Hu KQ, Hiatt JR, et al. Predictors of hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods during adult liver transplantation. Anesth Analg. 2007;105:780-5.
24. Apsner R, Schwarzenhofer M, Derfler K, Zauner C, Ratheiser K, Kranz A. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr. 1997;109:123-7.
25. Cote CJ, Drop LJ, Daniels AL, Hoaglin DC. Calcium chloride versus calcium gluconate: Comparison of ionization and cardiovascular effects in children and dogs. Anesthesiology. 1987;66:465-70.
26. Heining MP, Band DM, Linton RA. Choice of calcium salt. A comparison of the effects of calcium chloride and gluconate on plasma ionized calcium. Anaesthesia. 1984;39:1079-82.
27. Bull J, Band DM. Calcium and cardiac arrest. Anaesthesia. 1980;35:1066-7.
28. Fong J, Khan A. Hypocalcemia: Updates in diagnosis and management for primary care. Can Fam Physician. 2012;58:158-62.
29. Cote CJ. Depth of halothane anesthesia potentiates citrate-induced ionized hypocalcemia and adverse cardiovascular events in dogs. Anesthesiology. 1987;67:676-80.
30. Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26:377-84.
31. Aronson PS, Giebisch G. Effects of pH on potassium: New explanations for old observations. J Am Soc Nephrol. 2011;22:1981-9.
32. Takaichi K, Takemoto F, Ubara Y, Mori Y. Analysis of factors causing hyperkalemia. Intern Med. 2007;46:823-9.
33. Tsukamoto S, Maruyama K, Nakagawa H, Iwase Y, Kitamura A, Hayashida M. Fatal hyperkalemia due to rapid red cell transfusion in a critically ill patient. J Nippon Med Sch. 2009;76:258-64.
34. Aufhauser Jr DD, Rose T, Levine M, Barnett R, Ochroch EA, Aukburg S, et al. Cardiac arrest associated with reperfusion of the liver during transplantation: Incidence and proposal for a management algorithm. Clin Transplant. 2013;27:185-92.
35. Vannucci A, Burykin A, Krejci V, Peck T, Buchman TG, Kangrga IM. Postreperfusion cardiac arrest and resuscitation during orthotopic liver transplantation: Dynamic visualization and analysis of physiologic recordings. Shock. 2012;37:34-8.
36. Bailey DN, Bove JR. Chemical and hematological changes in stored CPD blood. Transfusion. 1975;15:244-9.
37. Smith HM, Farrow SJ, Ackerman JD, Stubbs JR, Sprung J. Cardiac arrests associated with hyperkalemia during red blood cell transfusion: A case series. Anesth Analg. 2008;106:1062-9.
38. Valeri CR. Blood components in the treatment of acute blood loss: Use of freeze-preserved red cells, platelets, and plasma proteins. Anesth Analg. 1975;54:1-14.
39. Jameson LC, Popic PM, Harms BA. Hyperkalemic death during use of a high-capacity fluid warmer for massive transfusion. Anesthesiology. 1990;73:1050-2.
40. Shi XY, Xu ZD, Xu HT, Jiang JJ, Liu G. Cardiac arrest after graft reperfusion during liver transplantation. Hepatobiliary Pancreat Dis Int. 2006;5:185-9.
41. Huang YR, Gu MN, Deng RJ, Xiao JF, Liang SW, Xu JS, et al. Management of hyperkalemia-induced cardiac arrest in anhepatic stage of orthotopic liver transplantation without venovenous bypass: Report of 3 cases. Di Yi Jun Yi Da Xue Xue Bao. 2004;24, 1210-1210-1,4. Epub 2004//-L1214.
42. Homvises B, Sirivatanauksorn Y, Limsrichamrern S, Pongraweewan O, Sujirattanawimol K, Raksakietisak M. The minimal flush volume for washout of preservation fluid in liver transplantation. Transplant Proc. 2008;40:2123-6.
43. El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol J. 2011;18:233-45.
44. Elliott MJ, Ronksley PE, Clase CM, Ahmed SB, Hemmelgarn BR. Management of patients with acute hyperkalemia. CMAJ. 2010;182:1631-5.
45. Ronco C, editor. Critical Care Nephrology - Renal Replacement Techniques: Descriptions, Mechanisms, Choices and Controversies. 2nd ed Philadelphia: Elsevier; 2009.
46. Dezwaan-McCabe D, Riordan JD, Arensdorf AM, Icardi MS, Dupuy AJ, Rutkowski DT. The stress-regulated transcription factor CHOP promotes hepatic inflammatory gene expression, fibrosis, and oncogenesis. PLoS Genet. 2013;9:e1003937.
47. Chung HS, Cho SJ, Park CS. Effects of liver function on ionized hypocalcaemia following rapid blood transfusion. J Int Med Res. 2012;40:572-82.
48. Urban P, Scheidegger D, Buchmann B, Barth D. Cardiac arrest and blood ionized calcium levels. Ann Intern Med. 1988;109:110-3.
49. Gruber M, Breu A, Frauendorf M, Seyfried T, Hansen E. Washing of banked blood by three different blood salvage devices. Transfusion. 2013;53:1001-9.
50. Niemann JT, Cairns CB. Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: possible culprits for postcountershock arrhythmias? Ann Emerg Med. 1999;34:1-7.
How to Cite
1.
Rando K, Vázquez M, Cerviño G, Zunini G. Hypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation. Colomb. J. Anesthesiol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 20];42(3):214-9. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/684
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2014-07-01
How to Cite
1.
Rando K, Vázquez M, Cerviño G, Zunini G. Hypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation. Colomb. J. Anesthesiol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 20];42(3):214-9. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/684
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Narrative review
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