{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:22:11Z","timestamp":1784697731876,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100016156","name":"U.S. Army Medical Research and Development Command","doi-asserted-by":"publisher","award":["CO230020"],"award-info":[{"award-number":["CO230020"]}],"id":[{"id":"10.13039\/100016156","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016156","name":"U.S. Army Medical Research and Development Command","doi-asserted-by":"publisher","award":["CO240027"],"award-info":[{"award-number":["CO240027"]}],"id":[{"id":"10.13039\/100016156","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypocalcemia is correlated with poor outcomes in trauma patients and is considered the fourth component in the \u201cdiamond of death\u201d alongside acidosis, coagulopathy, and hypothermia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>We characterized the kinetics of ionized calcium (iCa) at the point of injury and evaluated the efficacy of prehospital calcium supplementation in a rat model of lethal decompensated hemorrhagic shock. iCa and parathyroid hormone (PTH) were measured in models of hemorrhage\u2010alone (H) or blunt trauma with hemorrhage (TH). Linear regression was used to analyze the correlation between iCa and key laboratory parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both the H and TH models demonstrated a significant decrease in iCa shortly after the onset of injury. iCa levels were negatively correlated with heart rate, lactate, and sodium. A compensatory increase in PTH was observed in both models. In the H model, a single 20\u2009mg\/kg dose of calcium gluconate (CG) alone failed to improve survival. Plasma administration improved survival; however, concurrent administration of CG failed to fully correct hypocalcemia or provide additional benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that while hypocalcemia occurs early and consistently in both models of trauma\u2010hemorrhage, simple calcium repletion is insufficient to improve survival. The lack of additional benefit from calcium supplementation when combined with life\u2010saving plasma suggests that the underlying pathophysiology is more complex than a simple calcium deficit. Future strategies must look beyond mere repletion, investigate other primary drivers of trauma\u2010induced hypocalcemia, and optimize the dosing of calcium supplementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70176","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T05:21:42Z","timestamp":1774848102000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mapping ionized calcium levels and evaluating the outcome of prehospital calcium supplementation in acute trauma and hemorrhagic shock"],"prefix":"10.1111","volume":"66","author":[{"given":"Richard W.","family":"Walsh","sequence":"first","affiliation":[{"name":"Department of General Surgery University of Texas Health Science Center San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael 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Institute of Surgical Research  Fort Sam Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1024-0900","authenticated-orcid":false,"given":"Xiaowu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of General Surgery University of Texas Health Science Center San Antonio  San Antonio Texas USA"},{"name":"Blood and Shock Resuscitation United States Army Institute of Surgical Research  Fort Sam Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182755dcc"},{"issue":"1","key":"e_1_2_13_3_1","first-page":"85","article-title":"The trauma triad of death: hypothermia, acidosis, and coagulopathy","volume":"10","author":"Mikhail J","year":"1999","journal-title":"AACN Adv Crit 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