The authors reply

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We appreciate the interest in our study (1), recently published in Critical Care Medicine, and the insightful comments by Dotson (2). Dotson (2) hypothesized that calcium supplementation during sepsis might be harmful to patients (3). We could not test this hypothesis in an administrative database. Although an administrative database study has the advantage of large sample size and complete records on the outpatient medication use, it does not provide laboratory results and management details of the hospitalized inpatients. An electronic health record database may be a more suitable database to test this hypothesis. We agree that a randomized controlled trial will help elucidate the effect of calcium supplementation in patients with sepsis. However, it has to be mentioned that calcium is not only given in patients with hypocalcemia, but also widely used to protect the myocardium from the deleterious effects of hyperkalemia. Hyperkalemia is not uncommon in sepsis patients who are prone to develop lactic acidosis or acute kidney injury (4). These patients will have to be excluded from analysis in a randomized controlled trial. Therefore, it is likely that the interpretation of the results of a calcium supplementation in sepsis trial will be complicated.
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