{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T22:36:08Z","timestamp":1769207768369,"version":"3.49.0"},"reference-count":14,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2016,11,1]],"date-time":"2016-11-01T00:00:00Z","timestamp":1477958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>Parenteral calcium is frequently administered to critically ill patients. However, animal studies demonstrate that calcium administration during critical illness heightens inflammation and leads to shock, organ dysfunction, and mortality. We sought to evaluate the association between calcium administration and adverse outcomes in critically ill patients receiving parenteral nutrition (<jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort examined before and during a calcium gluconate shortage. During the shortage, calcium was absent from <jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content>, but calcium supplementation outside of <jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content> was allowed. The shortage resulted in a natural experiment that included a group of patients who did not receive calcium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Intensive care units (<jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>s) in three teaching hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 259 adults who received <jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content> in the <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> for 48 hours or longer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Patients were divided into quartiles based on amount of parenteral calcium received; the lowest quartile received no calcium. End points were in\u2010hospital mortality, acute respiratory failure, new\u2010onset shock, and a composite of any one of these end points. For patients not on mechanical ventilation or vasoactive support when <jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content> started, logistic regression revealed that calcium administration was associated with mortality (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 2.48, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 1.08\u20135.69), acute respiratory failure (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.43, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.28\u20134.60), new\u2010onset shock (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.81, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.22\u20136.44), and the combined end point (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.33, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.31\u20134.16). The odds of adverse outcomes increased as the calcium dose increased.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Calcium administration correlated with adverse outcomes in critically ill patients receiving <jats:styled-content style=\"fixed-case\">PN<\/jats:styled-content>. The data suggest that administration of parenteral calcium to critically ill patients may be harmful.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1849","type":"journal-article","created":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T17:23:23Z","timestamp":1476379403000},"page":"1185-1190","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Calcium Administration Is Associated with Adverse Outcomes in Critically Ill Patients Receiving Parenteral Nutrition: Results from a Natural Experiment Created by a Calcium Gluconate Shortage"],"prefix":"10.1002","volume":"36","author":[{"given":"Bryan","family":"Dotson","sequence":"first","affiliation":[{"name":"Department of Pharmacy Harper University Hospital Detroit Michigan"},{"name":"Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit 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