Life-threatening pulmonary hypertension and right ventricular failure complicating calcium and phosphate replacement in the intensive care

A 43-year-old man developed septic shock and acute lung injury after surgery to drain all ischiorectal abscess. In the intensive care unit lie initially improved but developed severe hypoxaemia, right ventricular failure and pulmonary hypertension 90 min after receiving intravenous calcium gluconate and potassium phosphate, best explained by the formation of a calcium-phosphate precipitant that resulted in aggregate anaphylaxis. His rapid deterioration and lack of response to conventional therapies necessitated support with extracorporeal membrane oxygenation that was life saving. This adverse event has altered local practice regarding calcium and phosphate replacement and has implications for all intensive care units.