The use of citrated blood for transfusion has become so common in the last twenty-five years that it would seem to be entirely safe if ordinary precautions are taken to resort to compatible blood and to avoid the presence of pyrogens. Nevertheless, some experiences which we have had have caused us to question the innocuousness of sodium citrate itself, when injected in large quantity. The possibility of an overdosage of sodium citrate was especially suggested by the unexplained death of a patient who received 4,000 cc. of citrated blood in six hours after a revision thoracoplasty.
The toxicity of sodium citrate was well known when Lewisohn1 introduced transfusion of citrated blood in 1915; its presence was blamed for the fact that the number of reactions associated with this method was greater than that associated with other methods (Unger,2 Bernheim3). Drinker and Brittingham4 and Unger5 advanced