61-63 Potassium increases in the plasma of stored blood as potassium leaves viable erythrocytes. These infusion rates may limit the time available for potassium redistribution to occur without resulting in hyperkalemia. Also, infants may receive disproportionately higher volumes of blood cells rapidly and will be at increased risk of acute hyperkalemia from stored blood. Washing the cells before administration removes the potassium. The electrocardiogram should be monitored in all patients for signs of electrolyte abnormality during rapid infusions.
Hyperkalemia exacerbates the cardiovascular effects of hypocalcemia.
Citrate toxicity occurs when ionized calcium is significantly reduced by citrate present in anticoagulant preservative solutions. The liver rapidly metabolizes citrate, and endogenous calcium stores are released to help prevent a fall in ionized calcium. However, in states of shock, these mechanisms may be impaired. Citrate toxicity is potentiated by the rapid administration of large volumes of citrated blood components. Toxicity is enhanced by hypothermia and depressed hepatic function that slow the normal rate of citrate removal by the liver.