You are teaching your junoir about medications use in Toxicology . He showed you the below medication and asked you the following :
Q.What are the common toxicology indication for it?
Q.What are the doses used?
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Calcium Booster!
Calcium Booster!
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Calcium Booster Cont’ Thanks for all of you for the excellent comments Calcium have many indication including the following and doses are depending on indication : 1. Symptomatic hypocalcemia resulting from intoxication by fluoride , oxalate ( ethylene glycol)or the IV anticoagulant citrate : give 20-30 ml of 10% calcium gluconate and repeat if needed 2. Hydrofluoric acid exposure : depending on route of exposure , for details ,see reference 3. Hypotension in the setting of calcium channel blocker overdose: start with 20-30 ml and going to higher dosage to reach 1.5 to 2 times the normal calcium level , administer calcium as 1 gram every 10-20 minutes or as continuous infusion 20-50 mg /kg /hr , serum calcium level should be measures every 2 hours with high dose calcium therapy 4. Severe hyperkalemia with cardiac manifestation: ve 20-30 ml of 10% calcium gluconate and repeat if needed 5. Symptomatic hypermagnesemia ;as above A 10 % solution of calcium chloride contain 3 times the amount of calcium than the 10% of calcium gluconate but need central line or big peripheral line due to risk of extravasation and tissue necrosis and it can not be used intradermal , subcutaneous or intra-arterial due the risk of tissue necrosis and damage Reference : 1. Olsen ‘s Poisoning and Drug Overdose , 6th edition
I like to mention that calcium chloride has three times as much calcium as calcium gluconate per ampoule can cause tissue damage if extravasates. So cannot use the chloride in small peripheral IV or intra-arterial or intradermal.
Common uses:
- Hyperkalemia
- Hypocalcemia (post thyroidectomy, parathyroid disease, fluoride, ethylene glycol, etc)
- Hypermagnesemia
Calcium gluconate (10%):
1. Contains 4.65 mEq of Ca 2+ per gram
2. 1g/10ml syringe (30mls=3g dose)
3. Preferred agent for peripheral administration
4. Risk of tissue necrosis and phlebitis is less
5. Can be given slow IV push
6. IV push only during ACLS
Toxicological indications: Hyperkalemia, Hypocalcemia, Hypermagnesemia, Beta blocker and Calcium channel blocker overdose (3-6g IV), Fluoride, Hydrofluoric acid, Ethylene glycol, Alpha- adrenergic antagonists