Abstract
Introduction: Many authors have tried to prove a causal relationship between hypocalcemia and increased mortality in ICUs. For many years correction of ionic calcium for albumin level and magnesium levels has been done. In vivo the importance of calculated ionic calcium for changes in pH has not been very well studied. Objective: The objective of our study is to find out if ionic calcium values (iCa) need to be corrected and calculated for in vivo acid base imbalances in ICU settings. Methods: The study was a time bound prospective study done from November 2016 to May 2017 in PICU of Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh. The ABGs and ionic calcium of all the critically ill children were collected according to inclusion & exclusion criteria. The iCalevels of the ABG machine was considered as the actual iCa value and the iCavalues were corrected for pH of 7.4 using the standard formula. The differences in ionic calcium levels and corresponding calculated ionic calcium levels were statistically analysed for significance using “paired t test”. Results: A total of 239 reports were studied, 80 records were acidotic, 78 exhibited normal pH and 81 had alkalosis. The difference between ionic calcium (iCa) and corrected ionic calcium (iCac) values were found significant [p=0.022] for moderate and severe acidosis. However, normal pH group [p=0.05186] and alkalosis group [p=0.0729] had insignificant differences. Conclusion: iCa, especially the actual iCa from the ABG reports should be considered for the treatment purposes specially in the case of acute acidosis.
Highlights
Many authors have tried to prove a causal relationship between hypocalcemia and increased mortality in ICUs
Singhi S C in 2003 found that the incidence of hypocalcemia and hypomagnesemia is high in sick pediatric patients and hypocalcemia is associated with significant increase in the mortality more so if hypocalcemia co-exists with hypomagnesemia [10,11] Ionic calcium is the biologically active form that is important in various metabolic activities of the body [8]; it is maintained in the plasma in a narrow range from 1.12 to 1.23 mmol regulated by Vitamin D and Parathyroid hormones [13]
We aimed to study the relevance of ionic calcium actual and the report received by correction for pH; as to which is better in the case of acid base imbalance in critically ill children
Summary
Many authors have tried to prove a causal relationship between hypocalcemia and increased mortality in ICUs. Objective: The objective of our study is to find out if ionic calcium values (iCa) need to be corrected and calculated for in vivo acid base imbalances in ICU settings. The difference between ionic calcium (iCa) and corrected ionic calcium (iCac) values were found significant [p=0.022] for moderate and severe acidosis. Acid base imbalances especially metabolic acidosis and alkalosis can alter the calcium albumin binding and affect the total calcium levels even in the presence of normal albumin levels [2,3]. Total and calculated ionic calcium correlate poorly to Manuscript received: 10th October 2018 Reviewed: 20th October 2018 Author Corrected: 26th October 2018 Accepted for Publication: 30th October 2018 the iCa levels and should not be used [4] in patients with acid base imbalances, renal and cardiac diseases. Animal studies have shown that acute changes in blood pH is the major determinant of changes in ionic calcium [6] because the binding of calcium to albumin is pH sensitive [7]
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