We studied 16 patients undergoing open-heart surgery and heart-lung bypass, to examine the relationship between ionized calcium and lactate. Blood was sampled at successive stages of the operation for measurement of ionized and total calcium, lactate, blood gases, pH, hematocrit, and other constituents. We found that correlations between ionized calcium and lactate were positive and statistically significant (p less than 0.05), both among and within patients. The linear regression of ionized calcium on lactate remained highly significant (p less than 0.0001) after adjustment for variability among patients and across operative stages as well as after correction for pH and hemodilution. The significant regressions between calcium and lactate, both before and after administration of calcium, indicate a relationship for calcium and lactate in patients undergoing open-heart surgery.