A Dyshomeostasis of Electrolytes and Trace Elements in Acute Stressor States: Impact on the Heart

Whitted, Anthony; Dube, Preeti; Komolafe, Babatunde O.; Davis, Richard C.; Soberman, Judith E.; Weber, Karl T.; Stanifer, John W.; Yusuf, Jawwad; Borkowski, Brian

doi:10.1097/maj.0b013e3181e5945b

Cited by 34 publications

(23 citation statements)

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“…Furthermore, intravenous calcium has an important role in hemodynamic support [31]. Interestingly, however, it has been shown that in sepsis and during treatment with catecholamines calcium is shifted into the cells, which may contribute to the hypocalcemia seen in the critically ill [7,32,33]. Raised intracellular calcium concentrations have in turn been linked to the pathophysiology of sepsis [33].…”

Section: Discussionmentioning

confidence: 99%

“…Abnormalities of parathyroid hormone secretion and action as well as vitamin D deficiency, medication side effects, transfusion of citrated blood and the effect of circulating catecholamines are likely to contribute [1,4-7]. Septic patients are at particular risk of hypocalcemia and this has been linked to both the bacteremic state and the effect of inflammatory mediators on parathyroid hormone secretion and function [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Assessment and clinical course of hypocalcemia in critical illness

et al. 2013

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IntroductionHypocalcemia is common in critically ill patients. However, its clinical course during the early days of admission and the role of calcium supplementation remain uncertain, and the assessment of calcium status is inconsistent. We aimed to establish the course of hypocalcemia during the early days of critical illness in relation to mortality and to assess the impact of calcium supplementation on calcium normalization and mortality.MethodsData were collected on 1,038 admissions to the critical care units of a tertiary care hospital. One gram of calcium gluconate was administered intravenously once daily to patients with adjusted calcium (AdjCa) <2.2 mmol/L. Demographic and outcome data were compared in normocalcemic (ionized calcium, iCa, 1.1-1.3 mmol/L) and mildly and severely hypocalcemic patients (iCa 0.9-1.1 mmol/L and <0.9 mmol/L, respectively). The change in iCa concentrations was monitored during the first four days of admission and comparisons between groups were made using Repeated Measures ANOVA. Comparisons of normalization and outcome were made between hypocalcemic patients who did and did not receive calcium replacement according to the local protocol. The suitability of AdjCa to predict low iCa was determined by analyzing sensitivity, specificity and receiver operating characteristic (ROC) curves. Multivariate logistic regression was performed to determine associations of other electrolyte derangements with hypocalcemia.Results55.2% of patients were hypocalcemic on admission; 6.2% severely so. Severely hypocalcemic patients required critical care for longer (P = 0.001) compared to normocalcemic or mildly hypocalcemic patients, but there was no difference in mortality between groups (P = 0.48). iCa levels normalized within four days in most, with no difference in normalization between those who died and survived (P = 0.35). Severely hypocalcemic patients who failed to normalize their iCa by day 4 had double the mortality (38% vs. 19%, P = 0.15). Neither iCa normalization nor survival were superior in hypocalcemic patients receiving supplementation on admission. AdjCa <2.2 mmol/L had a sensitivity of 78.2% and specificity of 63.3% for predicting iCa <1.1 mmol/L. Low magnesium, sodium and albumin were independently associated with hypocalcemia on admission.ConclusionsHypocalcemia usually normalizes within the first four days after admission to ICU and failure to normalize in severely hypocalcemic patients may be associated with increased mortality. Calcium replacement appears not to improve normalization or mortality. AdjCa is not a good surrogate of iCa in an ICU setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment and clinical course of hypocalcemia in critical illness

et al. 2013

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“…The new formula was found to be relatively independent of heart rate. These data suggest that this QT correction formula should of considerable value in identifying drug toxicity and electrolyte imbalance in patients with increases in heart rate [1,2,4,5]. QT heart rate adjustment formulae, including the one used herein, were been developed after examination of the QT intervals in different persons with different heart rates.…”

Section: Discussionmentioning

confidence: 99%

“…Catecholamine administration has been proposed as a diagnostic tool to unmask concealed long QT Syndrome [13]. Hyper adrenergic states are present in a number of clinical conditions and those associated with psychiatric conditions or in critically ill patients where the measurement of QT interval is an important consideration for assessment of drug toxicity or electrolyte abnormalities [2,4,14].…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of the QT interval on the ECG has attracted considerable attention as a marker for potential drug-induced cardiac toxicity or drug-induced sudden cardiac death [1][2][3], electrolyte abnormalities [4], as well as the NHANES sampling weight with spline parameters selected as those that minimized the least squares estimate fit of the QT-heart rate relationship [6]. The ECG exclusion criteria were abnormalities that made calculation of the QT interval difficult such as right or left bundle branch block, myocardial infarction left ventricular hypertrophy or rhythm not being sinus [6].…”

Section: Introductionmentioning

confidence: 99%

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Value of a New QT Interval Correction Formula in Adjusting for Increases in Heart Rate

Rabkin¹

2017

Int J Clin Cardiol

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identification of individuals with genetic mutations that carry a high risk of sudden death [5]. A new QT-heart rate correction formula (QTc) has been developed based on ECGs from about 13,600 individuals in the NHANES US population study [6]. This QTc was shown to be was superior to other formulae [6,7]. The value of this approach, however, has not been tested in the same individual under different conditions of heart rate stress.A critical aspect of the evaluation of the QT interval is its adjustment for heart rate because of the recognized inverse relationship between QT interval and heart rate. Studies that established QTc formulae including the most recent one, utilized data on different individuals who have different heart rates. While there is considerable power in the large numbers of individuals from population based studies, they do not address between individual variability. Specifically these studies are not able to take into consideration variables that produce different resting heart rates that might in turn influence the QT interval. The importance of the individual responses to test the robustness of the QT-heart rate correction formulae is well recognized [8]. The new QT-heart rate adjustment formula has not been subject to protocol driven changes in heart rate to determine whether QTc is stable when heart rate is increased. The objective of this study was to examine the new QT correction formula for its ability to remain stable in the same individual across a range of heart rates. Methods PopulationThe patient population were individuals who reAbstract Background and objective: QT interval correction for heart rate (QTc) is essential for clinical usage. A new QTc formula has been developed based on a data agnostic mathematical approach in a large population ECG data base. The formula requires testing on a within individual basis under conditions of intervention to increase heart rate. The objective of this study was to examine the stability and reliability the new QTc formulae within individuals when Heart Rate (HR) is increased by dobutamine.

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