Calcium gluconate, effect

Patients with acute hyperkalemia usually require other therapies to manage hyperkalemia until dialysis can be initiated. Patients who present with cardiac abnormalities caused by hyperkalemia should receive calcium gluconate or chloride (1 g intravenously) to reverse the cardiac effects. Temporary measures can be employed to shift extracellular potassium into the intracellular compartment to stabilize cellular membrane effects of excessive serum potassium levels. Such measures include the use of regular insulin (5 to 10 units intravenously) and dextrose (5% to 50% intravenously), or nebulized albuterol (10 to 20 mg). Sodium bicarbonate should not be used to shift extracellular potassium intracellularly in patients with CKD unless severe metabolic acidosis (pH less than 7.2) is present. These measures will decrease serum potassium levels within 30 to 60 minutes after treatment, but potassium must still be removed from the body. Shifting potassium to the intracellular compartment, however, decreases potassium removal by dialysis. Often, multiple dialysis sessions are required to remove potassium that is redistributed from the intracellular space back into the serum. 

In very high doses, aminoglycosides can produce a curare-like effect with neuromuscular blockade that results in respiratory paralysis. This paralysis is usually reversible by calcium gluconate (given promptly) or neostigmine. Hypersensitivity occurs infrequently. 

Neuromuscular paralysis This side effect most often results after direct intraperitoneal or intrapleural application of large doses of aminoglycosides. The mechanism responsible is a decrease in both the release of acetylcholine from prejunctional nerve endings and the sensitivity of the postsynaptic site. Patients with myasthenia gravis are particularly at risk. Prompt administration of calcium gluconate or neostigmine can reverse the block. 

Effective treatment of polymyxin-induced neuromuscular blockade requires awareness of the complication, with appropriate supervision and immediate ventilatory support, if required. Calcium gluconate and neostigmine are not of proven efficacy and should not be relied on (11). 

Quinuronium sulfate is a bitter, white to yellow, crystalline powder that is usually available as a stable 5% aqueous solution. This compound is effective in the treatment of B. caballi infections but is associated with relapses, making it more effective for premunition than for the elimination of infection. One treatment consists of two doses of a 5% solution of quinuronium sulfate, administered s.c. at 0.3mg/kg, 6h apart. Quinuronium sulfate has a narrow margin of safety and overdosing produces parasympathomimetic effects including tremors, salivation, urination and defecation. These signs usually respond to treatment with atropine, epinephrine (adrenaline) and calcium gluconate. The interval between treatments should not be shorter than 2 weeks and should preferably be 3 months because sensitization occurs, which results in shock, with a profound drop in blood pressure, and death. 

The victim s mouth should be washed out with copious amounts of water, atropine should be administered to control salivation. Barbiturates are used to control convulsions calcium gluconate may be used to control some physiologic effects. Phenoxybenza-mine and propranolol have been used experimentally to block a- and jS-adrenergic receptors. Life-support therapy may be used to maintain respiration and other vital functions. 

Intravenous injection of calcium gluconate can antagonize the cardiac effects of excess potassium. Also, intravenous injection of sodium bicarbonate and glucose will help diminish the effects of potassium hemodialysis overdose, while dialysis can be used to remove excess serum potassium. 

Administer calcium gluconate IV. Calcium antagonizes the effect of magnesium. 

The major side effect of chelation therapy, particularly with EDTA, is hypocalcaemia, a condition caused by too rapid administration of the chelator. The result is a rapid drop in the ionized calcium in the blood plasma that causes muscle and abdominal cramps, convulsions, and even death. The condition is usually controlled by infusion of calcium gluconate, or prevented when the metal to be removed complexes with a much higher stability constant with EDTA than that of the Ca-EDTA, by administration as the Ca-EDTA complex. 

Fiq. 7. The effect on systemic plasma calcium concentration of a 1-hour iv infusion of calcium gluconate, before and after thyroidectomy, in normal and methyl-thiouracil-treated pigs of similar age and weight. The shaded areas represent the periods of infusion (14 mg of Ca/kg of body weight/hour). [Redrawn from Duncan and Care (Dl).]... 

The most effective, specific antidote to HF and inorganic fluorides is calcium gluconate, which acts by precipitating fluoride ions as insoluble CaFj. After inhalation of HF vapor, treatment of the victim with dexamethasone aerosol is recommended, to prevent pulmonary edema. Even slight contamination with HF must always be taken seriously, and after the necessary first-aid measures a physician should be consulted as soon as possible. 

Effect op Four-Hooh Infusion of Calcium Gluconate on UmNAHY Phosphate/Creatinine Ratio in 14 Normal Subjects (N5, N15) ... 

The commonest form of treatment for acute hyperkalaemia is the infusion of insulin and glucose to move potassium ions into cells. An infusion of calcium gluconate may also be given to counter-aci the effects of hyperkalaemia. Dialysis is fretiticntly necessary to treat severe hyperkalaemia. When there is a slow rise in the plasma potassium this may be stopped or reversed by oral administration of a cation exchange resin such as Resonium A. 

Skin. Immediately flood exposed areas with water. Then soak in a solution of Epsom salts (magnesium sulfate) or calcium immediate topical use of calcium or magnesium may prevent deep bums. Some facilities that frequently manage HF cases purchase or prepare a 2.5% calcium gluconate gel (in water-based jelly), and this can be highly effective if applied immediately. Soaking in a dilute benzalkonium chloride (Zephiran) solution has been advocated as an alternative to calcium. 

Eyes. Flush with copious water or saline. The effectiveness of a weak (1-2%) calcium gluconate solution is not established. Consult with an ophthalmologist if there is evidence or suspicion of ocular exposure. 

Strontium-90 Alginate or aluminum hydroxide-containing antacids may reduce intestinal absorption of strontium. Dose 10 g, then 1 g 4 times daily. Barium sulfate may also reduce Sr absorption. Dose 100 g in 250 mL water PO. Calcium gluconate may dilute the effect of strontium. Dose 2 g in 500 mL PO or IV. Ammonium chloride is a demineralizing agent. Dose 3 g PO 3 times daily. 

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