Trauma-induced hypocalcemia

Transfusion. 2022 Aug:62 Suppl 1:S274-S280. doi: 10.1111/trf.16959. Epub 2022 Jun 24.


Background: Trauma-induced hypocalcemia is an underappreciated complication of severe injury but is well known to result in the derangement of an array of physiological regulatory mechanisms. Existing literature provides a compelling link between hypocalcemia and worse trauma-induced coagulopathy and increased mortality after injury.

Study design and methods: This narrative review evaluates available data related to the risk factors, mechanisms, and treatment of hypocalcemia after severe injury. The authors did not perform a systemic review or meta-analysis.

Results and discussion: The interplay of acidosis, hypothermia, and coagulopathy with hypocalcemia potentiates the bloody vicious cycle of hemorrhagic shock which has been the paradigm of trauma resuscitation for over half a century. However, current screening and treatment of postinjury hypocalcemia are relegated to a secondary consideration in trauma resuscitation. We conclude calcium supplementation should be a primary tier intervention for life-threatening injury.

Keywords: calcium supplementation; coagulopathy; death diamond; endotheliopathy of trauma; hemorrhagic shock; hemostasis; hypocalcemia; resuscitation; transfusion complications; transfusion practices; trauma.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Blood Coagulation Disorders* / etiology
  • Hemorrhage / etiology
  • Humans
  • Hypocalcemia* / etiology
  • Hypocalcemia* / therapy
  • Resuscitation / methods
  • Shock, Hemorrhagic* / complications
  • Shock, Hemorrhagic* / therapy
  • Wounds and Injuries* / complications
  • Wounds and Injuries* / therapy