Concerning disorders due to massive blood transfusion the citric acid intoxications, chiefly as to changes of serum Ca ion concentration, are experimentally and clinically studied.
1) The theoretical equations by McLean and Hastings which dealt with Ca ion cocentration in a solution containing Ca, protein and citric acid are developed further theoretically. And a nomogram is constructed by means of which theoretical values of serum Ca ion are able to be obtained from the measured values of serum protein, total citric acid and total Ca concentrations.
2) When citric acid is administered to dogs under minthal anesthesia by droplet infusion at a rate of 2 or 6mg/kg/Min., the concentrations of both serum total Ca and citric acid rapidly increase,1 hour later reaching their peaks at the end of infusion, and decrease again. Especially the concentration of serum citric acid increases as rapidly as it is reduced, and a pyramidal curve is obtained having a peak at the end of infusion. The serum Ca ion concentration is reduced by the infusion at a rate of 6 mg/kg/Min. in accordance with increasing total citric acid concentration. However it is restored very rapidly. The blood clotting time is also in accordance with the decrease of Ca ion cocentration, but temporarily significantly delayed. No significant reduce of serum Ca ion concentration is observed by the infusion at a rate of 2mg/kg/Min.
It is cleared that aspects of both citric ecid metabolism and the changes of serum Ca ion are not significantly influenced by approximately 50% liver excision.
3) Although, in such dogs as in impending stage of hemorrhagic shock, the concentration of serum citric acid increases rapidly by ACD-blood transfusion and decreases again, the rate of decrease is relatively slow. And the total Ca concentration increases only little by transfusion. But because of relatively small amount of transfused ACD-blood, the serum Ca ion does not decrease so remarkably. Although the serum K concentration increases after bloodletting, it is recognized that it has been rather a little decreased since ACD-blood transfusion. The serum amino-N, according as advance of shock increases slowly and it does further increase after transfusion, being maintained at relatively high levels.
4) When the citric acid is infused by droplet infusion at a rate of 2mg/kg/Min. during 30 minutes to the preoperative tuberculous patients, the concentration of serum total citrit acid as rapidly increases and decreases again as in the case of dogs. However the total Ca concentration does not change so remarkably, and the Ca ion concentration as well as the blood clotting time also does not alter significantly.
5) In the case of thoracic operations which usually need relatively massive stored blood transfusions, the serum total citric acid concentration is continuously at high levels during whole course of the transfusion, and it, reaching the highest level soon after beginning of the transfusion or at the time of rapid infusion, is restored considerably rapidly after finishing of transfustion and reaches the level observed before transfusion. The total Ca concentration rather a little decreases after beginning of transfusion and, although it increases again, generally remaing at a little lower levels than before transfusion. The concentration of serum Ca ion also decreases after beginning of transfusion in accordance with the changes of both total Ca and citric acid concentrations, however no case are investigated which show remarkable symptomes of hypocalcemia.
View full abstract