Figure 60-13 Ionized hypocalcemia always accompanies the administration of citrated blood products (fresh frozen plasma, citrated whole blood). Fresh frozen plasma has the highest concentration of citrate per unit volume of any blood product and is the most likely to cause ionized hypocalcemia during rapid infusion. Studies in children with severe thermal injuries suggest that rates exceeding 1.0 mL/kg/min produce severe ionized hypocalcemia. If no additional citrated blood products are administered, this abnormality corrects itself because of metabolism of the citrate. However, patients with impaired hepatic blood flow (infants, liver transplant patients, trauma patients) may need exogenous calcium therapy. *P < .001; †P < .0021 versus baseline. (From Coté CJ, Drop LJ, Hoaglin DC, et al: Ionized hypocalcemia after fresh frozen plasma administration to thermally injured children: Effects of infusion rate, duration, and treatment with calcium chloride. Anesth Analg 67:152–160, 1988.)