The Cardiac Effect of Altered Calcium Homeostasis after Albumin Resuscitation

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Abstract
Supplemental albumin added to a standard non-albumin resuscitation regimen significantly impairs heartwork in seriously injured patients. The role of Ca dynamics in this myocardial depression was analyzed in 94 injured patients who were in shock for an average of 32 min and received an average of 14.5 transfusions, 9.2 L crystalloid, 0.9 L plasma, and 20.9 meq Ca prior to the end of operation. By random selection, 44 patients received an average of 31 g of albumin during operation, 207 g during the early postoperative period (mean = 30 h) of extravascular fluid sequestration, and 402 g during the mobilization period. The albumin resuscitated patients had normal total protein and serum albumin levels and higher total Ca (TC) levels, however, they had a significantly lower Ca2+ and Ca2+/TC. The accumulative slope for heartwork/filling pressure was significantly depressed in albumin patients as was the mean work unit/filling pressure index. The level of Ca2+ and the Ca2+/TC ratio correlated directly with the calculated work unit index in the albumin and non-albumin patients. Supplemental albumin apparently binds serum Ca2+, causing an increase in TC but a reduction in Ca2+ and Ca2+/TC. The fall in Ca2+ and Ca2+/TC seems responsible for heart failure and pulmonary edema in albumin resuscitated patients.

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