This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lepage, R. Articles by D’Amour, P. Search for Related Content PubMed PubMed Citation Articles by Lepage, R. Articles by D’Amour, P.

Hypocalcemia Induced during Major and Minor Abdominal Surgery in Humans

Research Center, Campus Saint-Luc, and the Departments of Biochemistry (R.L.), Medicine, and Surgery (G.L., C.R., R.L., M.D.), Centre Hospitalier de l’Université de Montréal, Montreal, Canada

Address all correspondence and requests for reprint to: Pierre D’Amour, M.D., Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Campus Saint-Luc, 264 René Lévesque boulevard East, Montreal, Quebec, Canada H2X 1P1

Hypocalcemia has only been rarely reported during surgical procedures not involving massive blood transfusions. The frequent observation in our hospital of a low serum ionized calcium level during surgery in nonacutely ill patients prompted us to investigate the calcium-PTH axis in three groups of subjects undergoing major (hepatectomy; n = 10), moderately severe, or minor surgery under general anesthesia (colectomy; n = 7, herniorrhaphy; n = 9) compared to that in one group of minor surgery cases under epidural anesthesia (herniorrhaphy; n = 15). Serum samples were obtained before anesthesia, after anesthesia but before surgery, and 40 and 120 min after the beginning of surgery in all groups of patients and for up to 3 days in major and moderately severe cases. Significant falls (P < 0.01), always proportional to the severity of the surgical/anesthesia procedure, were observed for ionized calcium (6–20%), total calcium (8–19%), and albumin (8–23%) accompanied by increases in intact PTH (105–635%). The decrease in ionized and total calcium correlated with a decrease in albumin (P < 0.001). Phosphorus, pH, and magnesium levels remained within the normal range. Adjustment of ionized calcium for variation in albumin revealed that 50–100% of the variation in ionized calcium could be attributed to a fall in albumin resulting from fluid administration to patients before admission to the surgery ward and between the onset of anesthesia and the end of surgery (1.2–5.6 L). Albumin- and pH-independent residual ionized calcium decreases of 12.2% in the hepatectomy group, 4.6% in the group of moderately severe and minor cases under general anesthesia, and 3.7% in the control group reflected the severity of the surgical/anesthesia procedure.

This article has been cited by other articles:

				L. Canaff, X. Zhou, and G. N. Hendy The Proinflammatory Cytokine, Interleukin-6, Up-regulates Calcium-sensing Receptor Gene Transcription via Stat1/3 and Sp1/3 J. Biol. Chem., May 16, 2008; 283(20): 13586 - 13600. [Abstract] [Full Text] [PDF]

				L. Canaff and G. N. Hendy Calcium-sensing Receptor Gene Transcription Is Up-regulated by the Proinflammatory Cytokine, Interleukin-1{beta}: ROLE OF THE NF-{kappa}B PATHWAY AND {kappa}B ELEMENTS J. Biol. Chem., April 8, 2005; 280(14): 14177 - 14188. [Abstract] [Full Text] [PDF]