Life‐threatening pulmonary hypertension and right ventricular failure complicating calcium and phosphate replacement in the intensive care unit

  title={Life‐threatening pulmonary hypertension and right ventricular failure complicating calcium and phosphate replacement in the intensive care unit},
  author={Timothy Felton and B. A. McCormick and Simon R. Finfer and Malcolm Fisher},
A 43‐year‐old man developed septic shock and acute lung injury after surgery to drain an ischiorectal abscess. In the intensive care unit he initially improved but developed severe hypoxaemia, right ventricular failure and pulmonary hypertension 90 min after receiving intravenous calcium gluconate and potassium phosphate, best explained by the formation of a calcium‐phosphate precipitant that resulted in aggregate anaphylaxis. His rapid deterioration and lack of response to conventional… 
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A response to ‘Life‐threatening pulmonary hypertension and right ventricular failure complicating calcium and phosphate replacement in the intensive care unit’
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Microvascular pulmonary emboli secondary to precipitated crystals in a patient receiving total parenteral nutrition: a case report and description of the high-resolution CT findings.
A patient with a history of a small-bowel transplant that was subsequently resected required total parenteral nutrition for nutritional supplementation and developed chest tightness, shortness of breath, and fever, and amorphous material obstructing the pulmonary microvasculature was revealed.
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Fatal microvascular pulmonary emboli from precipitation of a total nutrient admixture solution.
Pulmonary embolization of a precipitate containing calcium phosphate resulted in the death of two patients and the pH of the amino acid component, transient elevation of calcium and phosphorus concentrations during mixing, and the lack of agitation during automated preparation of the formulation were identified as the etiologic factors producing the fatal precipitate.
Clinical Observations on the Pathophysiology and Treatment of Anaphylactic Cardiovascular Collapse
  • M. Fisher
  • Medicine
    Anaesthesia and intensive care
  • 1986
Observations in 205 patients with cardiovascular manifestations of anaphylactic shock confirmed the belief that adrenaline is the drug of first choice in management and that colloid solutions are