%0 Journal Article %J The American surgeon//Am Surg %D 1992 %T JOURtrolyte and acid-base changes with massive blood transfusions. %A Wilson, R F %A Binkley, L E %A Sabo, F M Jr %A Wilson, J A %A Munkarah, M M %A Dulchavsky, S A %A Diebel, L N %K *Blood Transfusion/ae [Adverse Effects] %K *Hemorrhage/th [Therapy] %K *Water-Electrolyte Imbalance/ep [Epidemiology] %K Blood Gas Analysis %K Blood Proteins/an [Analysis] %K Blood Transfusion/sn [Statistics & Numerical Data] %K Calcium/bl [Blood] %K Hemorrhage/et [Etiology] %K Hospitals, University %K Humans %K Incidence %K JOURtrolytes/bl [Blood] %K Magnesium/bl [Blood] %K Michigan/ep [Epidemiology] %K Survival Rate %K Treatment Outcome %K Water-Electrolyte Imbalance/bl [Blood] %K Water-Electrolyte Imbalance/et [Etiology] %X The case records of 471 patients with massive transfusions of ten or more units of bank blood within 24 hours were reviewed to analyze the electrolyte and acid-base changes. The patients who lived had a less severe acidosis (7.23 +/- 0.15 vs 7.11 +/- 0.17) and the HCO3 was higher (19.8 +/- 15.2 vs 13.4 +/- 6.8) (P less than 0.001). The mean anion gap, despite the low HCO3, was 11.8 +/- 7.8 mEq/L. A combined metabolic and respiratory acidosis, often following bicarbonate therapy, was fetal in 83 per cent (39/47). Serum potassium values (K) were high in 22 per cent and low in 18 per cent of patients. If potassium levels were "corrected" by subtracting 0.5 mEq/L for each 0.1 pH of metabolic acidosis, only 5 per cent of patients were hyperkalemic. Patients dying within 48 hours of the massive transfusions had higher potassium levels (4.9 +/- 1.1 vs 4.4 +/- 0.9; P less than 0.001). Ionized calcium levels (Ca++) were less than normal (1.13-1.32 mmol/L) in 94 per cent of patients and were very low (less than 0.70 mmol/L) in 46 per cent (108/234). The mortality rate with severe ionic hypocalcemia was 71 per cent (vs 40% in patients with more normal values); P less than 0.0001. pH, PCO2, K, and Ca++ must be followed closely with massive transfusions. Rapid correction of volume and pH, without overcorrection, is essential. %B The American surgeon//Am Surg %I Wilson,R F. Department of Surgery, Detroit Receiving Hospital, Michigan. %C UNITED STATES %V 58 %P 535 - 5 %8 1992 %@ 0003-1348 %G eng %N 9 %< http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med3&NEWS=N&AN=1524320