CHEST Guidelines-Serum-Calcium-Values-and-Refractory-Vasodilatory-S (1)

Serum-Calcium-Values-and-Refractory-Vasodilatory-S (1)

Pdf Summary

The exchange in question pertains to a discussion about the role of serum calcium levels in vasodilatory shock, as outlined in a review by Jentzer et al., published in CHEST. Salvatore Minisola and colleagues express interest in the review, acknowledging the mention of hypocalcemia but critiquing the limited clarity on how reduced calcium could lead to vasodilatory shock. They argue that low serum calcium might rather be an epiphenomenon rather than a causative factor. They mention cases where hypocalcemic cardiomyopathy was reversed through calcium supplementation, citing the essential role of calcium in muscle contraction, supported by experimental evidence of hypocalcemia's impact on cardiac contractility.<br /><br />Minisola et al. advocate for further studies to explore the potential pathogenetic role of hypocalcemia in vasodilatory shock contexts. In response, Jentzer and colleagues acknowledge the complexity and controversy of treating ionized hypocalcemia in such conditions, noting the lack of high-quality evidence to definitively establish a cause-and-effect relationship or the benefits of calcium repletion in shock scenarios. They recognize that low ionized calcium levels are frequently linked to hypotension and adverse outcomes in critically ill patients, but the specific benefits of calcium correction remain unproven.<br /><br />Moreover, Jentzer's team references prior studies associating hypocalcemia with reversible ventricular dysfunction, reinforcing the crucial role of calcium for cardiovascular health. They highlight the conspicuous absence of standardized guidelines to determine optimal calcium levels that should guide clinical interventions. The discussion signifies the broader uncertainty in the medical community concerning whether hypocalcemia plays an active role in exacerbating refractory shock or is simply an associated phenomenon.

Keywords

serum calcium

vasodilatory shock

hypocalcemia

cardiomyopathy

calcium supplementation

cardiac contractility

pathogenetic role

ionized hypocalcemia

ventricular dysfunction

calcium repletion