Why the study?
Does calcium administration prevent or reverse citrate intoxication during exchange transfusions with ACD blood?
Does calcium administration prevent or reverse citrate intoxication during exchange transfusions with ACD blood?
Calcium administration has been historically used to reverse the electrocardiographic and systemic effects of citrate intoxication from ACD blood transfusions, though ionized calcium increases may be unpredictable.
Calcium supplementation during ACD exchange transfusion produces unpredictable ionized calcium rises; leaves open whether routine use prevents citrate toxicity in neonates.
CITRATE INTOXICATION, which can result from the use of large amounts of stored blood containing the anticoagulant, acid-citrate-dextrose (ACD) solution, has been shown to be a danger in experimental animals¹⁻⁴and in clinical cases.⁵Infusions of the ACD solution alone into laboratory animals can produce the same untoward effects. The citrate itself, low pH, lack of ionized calcium, excess potassium, and alterations in the potassium: calcium ratio have each been considered the dangerous factor. Foote, Trede, and Maloney₆successfully used ACD blood to prime heart-lung machines after giving sufficient calcium to the patient to reverse the alterations in the electrocardiogram. Bunker and associates⁷were able to reverse the effects of sodium citrate by the intravenous administration of calcium chloride, but they found that the increase in ionized calcium in the blood could not be predicted on the basis of the amount of calcium administered. When the
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Thomas F. Nealon (1963) studied this question.