ER Board Practice Questions - Saudi Board Emergency Medicine Final Written Exam

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A 34-year-old female is brought to the resuscitation bay in hemorrhagic shock after a pelvic crush injury. Her blood pressure is 74/40 mmHg and heart rate is 135 bpm. The massive transfusion protocol (MTP) is activated. After the administration of 6 units of packed red blood cells (PRBCs) and 6 units of fresh frozen plasma (FFP), the patient develops QTc prolongation and muscle tremors. Which of the following is the most likely cause of these symptoms?

Hyperkalemia from rapid RBC lysis Hypocalcemia caused by citrate toxicity Hypomagnesemia from dilutional coagulopathy Metabolic acidosis from tissue hypoperfusion

Correct Answer:

Hypocalcemia caused by citrate toxicity

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