When it comes to trauma, new research is showing that hypocalcemia, the loss of calcium due to blood loss, is also a factor in the “lethal triad” of acidosis, coagulopathy, and hypothermia. This condition can be further exacerbated by the citrates found in preserved blood, worsening hypocalcemia in patients. The addition of hypocalcemia to the triad would create the “lethal diamond”. As stated in the attached article, “it is hoped that this increased focus on hypocalcemia in trauma can lead to research regarding early administration of calcium with the hopes of improving trauma patient outcomes.”

Ditzel RM Jr, Anderson JL, Eisenhart WJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond?. J Trauma Acute Care Surg. 2020;88(3):434-439. doi:10.1097/TA.0000000000002570

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