In a literature review published in The Journal of Trauma and Acute Care Surgery, researchers examined the prevalence of hypocalcemia, a condition in which there are low levels of calcium in plasma, among trauma patients and the need to address this deficiency in management of the severely injured.
The review, co-authored by Ricky Ditzel, an undergraduate student in both the Emergency Health Services (EHS) and the Leadership for Emergency Action and Disaster Response programs at the George Washington University School of Medicine and Health Sciences, and William Eisenhart, adjunct instructor in EHS and Clinical Research and Leadership, sought to gather information that could be used to promote the need for research in the management of hypocalcemia in trauma patients.
“We believe that early identification and correction of hypocalcemia in this patient population could be a missing link to the management and prevention of trauma-induced coagulopathy (inability to form blood clots) and effectively change the descriptor from the lethal triad to the lethal diamond,” the paper’s authors wrote.
Patients who continue to suffer from shock or hypoperfusion are at greater risk of morbidity and mortality because of blood failure precipitated by the lethal triad — hypothermia, coagulopathy, and acidosis — a process caused by increased acidity in the blood. The paper’s authors propose a lethal diamond, which would add hypocalcemia to that list.
From the review, the researchers found that more than half of trauma patients are hypocalcemic before receiving any blood products on arrival to an emergency department. In addition, transfusions increased the severity of hypocalcemia, leading to worsening ionized calcium levels, which can be associated with increased mortality.
The reviewed showed a need for a randomized trial to determine whether findings from the review are correlation or causation.
Such a study could “result in better outcomes for trauma patients using the lethal diamond as a reference, focusing on early administration of calcium products to trauma patients expected to receive transfusion,” according to the article.
The review article, “A review of transfusion- and trauma-induced hypocalcemia,” was published in The Journal of Trauma and Acute Care Surgery.
