Abstract
Purpose: This case report describes the intra-operative management of a proolonged QT interval in the setting of massive transfusion.
Clinical Features: A previously healthy, 45-yr-old man presented for repair of a class IV thoraco-abdominal aneurysm. The initial stages of the operation were relatively uneventful, with the exception of an estimated blood loss of 5.0 L. At this point the patient’s QT interval became markedly prolonged, and subsequently narrowed in response to supplemental calcium and magnesium. A blood sample taken just before QT prolongation revealed an ionized calcium of 0.98 mmol·L−1 and an ionized magnesium of 0.37 mmol·L−1, indicating, that low magnesium may have contributed to the QT interval prolongation.
Conclusion: This case illustrates the importance of following both ionized calcium and magnesium in the setting of a massive transfusion.
Résumé
Objectif: L’observation suivante décrit le traitement peropératoire d’un intervalle QT prolongé dans le cadre d’une transfusion massive.
Éléments cliniques: Un homme de 45 ans, auparavant en bonne santé, a été admis pour la réparation d’un anévrisme thoraco-abdominal de classe IV. L’opération se déroulait sans incident, ausf pour une perte sanguine d’environ 5,0 L. Puis, l’intervalle QT s’est allongé de façon marquée pour ensuite se rétrécir, en réponse au callcium et au magnésium thérapeutiques. L’analyse de sang prélevé juste avant la prolongation QT a révélé la présence de calcium ionisé à 0,98 mmol·L−1 et de magnésium ionisé à 0,37 mmol·L−1, ce qui pouvait indiquer que le bas taux de agnésium avait contribué à la prolongation de l’intervalle QT.
Conclusion: Ce cas illustre l’importance de tester le calcium et le magnésium ionisé au cours du traitement d’une transfusion massive.
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Meikle, A., Milne, B. Management of prolonged QT interval during a massive transfusion: calcium, magnesium or both?. Can J Anesth 47, 792–795 (2000). https://doi.org/10.1007/BF03019483
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DOI: https://doi.org/10.1007/BF03019483