CHEST Guidelines-Serum-Calcium-Values-and-Refractory-Vasodilatory-S

Serum-Calcium-Values-and-Refractory-Vasodilatory-S

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The letter to the editor outlines a discussion on the potential role of hypocalcemia in refractory vasodilatory shock. The original review article in CHEST by Jentzer et al. addresses management strategies for this condition, hinting at the possible etiological role of low serum calcium levels. However, the authors clarify that the presence of low calcium should be treated as an epiphenomenon rather than a primary pathogenetic mechanism. They remain cautious about the safety and efficacy of using calcium infusion as a rescue therapy due to insufficient evidence.<br /><br />The letter by Salvatore Minisola and colleagues points out instances of hypocalcemic cardiomyopathy where normalization of serum calcium levels, achieved through calcium and vitamin D or recombinant human parathyroid hormone treatment, led to improvement in heart ejection fraction and contractile performance. These observations align with established physiological concepts that highlight calcium's crucial role in muscle contraction, suggesting it might have a similar function in vasodilatory shock scenarios. They propose that more research is needed to understand further the role of reduced serum calcium in vasodilatory shock.<br /><br />In response, Jentzer and colleagues acknowledge the letter's insights but emphasize the lack of high-quality evidence to address ionized hypocalcemia's significance in critical illness, which frequently shows association with hypotension but lacks a demonstrated cause-and-effect relationship. They note the simplicity of correcting hypocalcemia in clinical practice but also highlight the absence of specific guidelines on optimal calcium levels for effective repletion. They further discuss the potential contribution of hypocalcemia to refractory shock but reiterate the uncertainty around it being a causative factor or merely a coincidental finding, calling for further investigation to clarify these issues.

Keywords

hypocalcemia

vasodilatory shock

calcium infusion

cardiomyopathy

serum calcium

muscle contraction

critical illness

hypotension

calcium repletion

research