Intravenous Administration Of Calcium Gluconate Research Articles

Ventricular fibrillation in a dog with refractory hyperkalaemia due to uroabdomen following extradural anaesthesia

AbstractA young adult, crossbreed dog was presented to a referral small animal veterinary hospital with uroabdomen causing a severe hyperkalaemia. Stabilisation of the condition consisted of abdominocentesis and intravenous administration of calcium gluconate, insulin, glucose and crystalloids. The patient was then anaesthetised for diagnostic and therapeutic procedures. An epidural was performed with levobupivacaine due to nociception and requirement for exploratory surgery. Marked bradycardia ensued and was treated with anticholinergics and terbutaline, among other repeated efforts to resolve a pharmaceutically resistant hyperkalaemia. However, cardiorespiratory arrest followed, characterised by ventricular fibrillation. Cardiopulmonary resuscitation utilised cardioversion to achieve return of spontaneous circulation within 16 minutes. After return of spontaneous circulation, serum potassium levels only decreased and remained below 7 mmol/L after repeat abdominocentesis, alongside continued medical therapy. Unfortunately, despite successful recovery from general anaesthesia, the patient later developed surgical wound dehiscence and was euthanased as a result.

Effectiveness of supplemental oral calcium drink in preventing citrate-related adverse effects in peripheral blood progenitor cell collection

Peripheral blood progenitor cells (PBPCs) are a predominant graft source in allogeneic hematopoietic cell transplantation. Citrate-induced hypocalcemia remains the most frequent side effect of PBPC apheresis. Although the method for preventing severe adverse events is established, more efficient prophylaxis is required so that volunteer donors can donate PBPCs without pain and anxiety. We studied 80 healthy donors who underwent PBPC harvest between February 2014 and June 2020. Of these, 23 donors who underwent apheresis between February 2014 and December 2015 received only the standard prophylaxis of intravenous calcium gluconate. Oral calcium drinks were provided to 57 donors who underwent apheresis from January 2016 to June 2020 to supplement intravenous calcium gluconate prophylaxis. The ionized calcium (ICa) levels at multiple time intervals and the hypocalcemic symptoms were evaluated. Oral supplementation with a calcium drink maintained significantly higher ICa levels. Analysis using the inverse probability weighted regression adjustment method suggested that calcium drinks reduced the frequency of citrate-related reactions by 39.2 %. Administering a prophylactic oral calcium drink before apheresis with intravenous administration of calcium gluconate is promising to further reduce citrate-induced hypocalcemia in volunteer donors.

Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

Background: Hypoparathyroidism and hypocalcemia is a common postoperative complication, after total thyroidectomy due to thyroid cancer. Standard treatment with supplementation of calcium and vitamin D analogs, usually treat this condition. In some patients, hypoparathyroidism is refractory to standard treatment plus intermittent calcium infusions with persistent low serum calcium levels and associated clinical complications. Attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. To our knowledge, this is the first time that we encounter a patient suffering from treatment-refractory postsurgical hypoparathyroidism who was treated with teriparatide.
 Case presentation: Male (31 years) with postoperative hypoparathyroidism, after total thyroidectomy due to papillary thyroid cancer, several weeks after the surgery still required intermittent intravenous calcium infusions because of tetany symptoms. He had persistent hypocalcemia despite oral treatment with up to 1 ug calcitriol and 4 g calcium per day necessitating additional intravenous administration of calcium gluconate intermittently. This time, Teriparatide treatment was introduced at once daily 50 micrograms (mcg) subcutaneous injection, while doses of calcium and calcitriol were gradually decreased depending on the response of serum total and ionized calcium taken periodically, which resulted in total resolution of hypocalcemia symptoms and the achievement and maintenance of laboratory normocalcaemia in just 5 days.
 Conclusion: Treatment refractory chronic hypoparathyroidism may be seen in some cases after total thyroidectomy. Furthermore, the use of recombinant human parathyroid hormone analog (Teriparatide) allows for the control of recurrent hypocalcemia reducing the daily dosage of calcium and vitamin D. Finally, regular intravenous calcium administration was no more needed.

Cutaneous calcinosis induced by intravenous calcium gluconate administration

Cutaneous calcinosis induced by intravenous calcium gluconate administration

Unsuspected malabsorption as a cause of severe acute hypocalcemia in a treated-autoimmune hypoparathyroidism (APS1)

Autoimmune polyendocrinopathy type 1 (APS1), or APECED syndrome, is a rare genetic disease. Auto-immune hypoparathyroidism is usually the first clinical manifestation and the most prevalent disease. Treatment will depend on the affected organ and could be challenging throughout life, especially because of development of combination of different auto-immune disorders. A 22-year-old woman was diagnosed for hypoparathyroidism at the age of 4 after seizure caused by hypocalcemia. At 14-year-old, she developed an ovarian failure. At that time, APS1 was confirmed by molecular analysis showing a mutated AIRE gene. Serum calcium was stable over time under oral calcium (1.5 g/day) and calcitriol (0.75 μg/day). Despite persistent adherence to the treatment, she was admitted for severe acute hypocalcemia (corrected serum calcium: 1.3 mmol/L). In addition to hypocalcemia related-tetany, she complained of abdominal pain and diarrhea. Biology revealed inflammatory syndrome. Repeated microbiological samples remained negative. Acute treatment was initiated with intravenous administration of calcium gluconate. Persisting hypocalcemia required increased oral doses of calcium (4 g/day) and calcitriol (2 μg/day). 1,25-dihydroxy-vitamin D raised slightly despite the doubling of calcitriol dose (from 28.5 to 50.5 pg/mL [N: 22–111]). Therefore, malabsorption syndrome was suspected and finally confirmed by the presence of a steatorrhea with a steatocrit value of 82%. High dose of calcium and calcitriol use is limited by the risk of hypercalcemia and by side effects as nephrolithiasis. This case illustrates the necessity to test new therapies like subcutaneous recombinant PTH that could be a good alternative for patients with hypoparathyroidism associated with malabsorption.

No need to wait for the blood tests: the clinical diagnosis of hypocalcemia

A 75 years old woman, with a history of cervical cancer, liver and pulmonary metastases, presented to the Emergency Department of our hospital with generalized tonic-clonic seizures. She had an abnormal ECG, mainly characterized by a prolonged QT interval. Trousseau sign was elicited after the sphygmomanometer cuff was inflated to more than the systolic blood pressure on her left arm. In view of these findings, we strongly considered hypocalcemia as the cause of seizures and laboratory investigations confirmed our primary clinical suspicion: she had a corrected blood calcium level of 7 mg/dl (normal values 8.1-10.4 mg/dl). The patient was admitted for further evaluation and her initial treatment included intravenous administration of calcium gluconate. A cranial CT scan was performed, which excluded brain metastases. She was discharged five days later on oral calcium supplements. In conclusion, nowadays, that technology has deeply penetrated the clinical practice, physicians should never forget that in most cases, a thorough physical examination of the patient is enough to set the diagnosis.

Unusual Presentation of Calcinosis Cutis: Venous Calcification Following intravenous Calcium Gluconate Administration in a Preterm Baby

Unusual Presentation of Calcinosis Cutis: Venous Calcification Following intravenous Calcium Gluconate Administration in a Preterm Baby

Does standard intravenous calcium gluconate administration during peripheral blood stem cell collection reduce the chance of a citrate reaction?

To prevent blood clotting during stem cell collection Acid Citrate Dextrose- formula A (ACD-A) (Haemonetics) is given routinely in our center in a range of 1:12mL. Citrate in itself can cause common side effects such as tingling, parenthesis, nausea/vomiting and muscle cramps. These side effects can be treated by the administration of Calcium orally, or intravenously. In our center 179 procedures were performed in 142 patients from January 2009 until February. Patients were diagnosed with Non Hodgkin Lymphoma (NHL) 24, Multiple Myeloma (MM) 61,Hodgkin Lymphoma (HL) 18, Mantle cell Lymphoma (MCL) 18, Acute Myeloid Leukemia (AML) 17, Testis Carcinoma 4.

Intravenous administration of calcium in ovarian hyperstimulation syndrome (OHSS) prevention

Evaluation of the effectiveness of intravenous administration of calcium gluconate in preventing the development of clinical symptoms of OHSS. Prospective double-blind clinical trial. 108 in vitro fertilization patients were administered intravenously either 10 mL 10% calcium gluconate (62 women) or 1,000 mL of 6% hydroxyethyl starch (46 women) on the day of oocyte retrieval (OR) and Days 1, 2, and 3 post-OR. The principal inclusion criteria were symptoms of the high risk of OHSS (development of ≥20 follicles >10 mm on Day 6 of controlled ovarian hyperstimulation, estradiol level on the day of OR ≥3,000 pg/mL, age < 30 years old and body mass index (BMI) < 25 kg/m2). Symptoms of OHSS (lower abdominal discomfort, abdominal distension, nausea and/or vomiting, rapid weight gain, dyspnoea, and progressive oliguria), volumes of ovaries and ascites were observed. The differences in the clinical symptoms of OHSS among the groups were statistically significant (P<0.0001). The ovarian volume did not differ (P>0.07) between the groups until Day 10 post-OR; later was observed the significant (P<0.0001) decrease of the ovarian volume in the calcium group. The ascites volume was significantly lower in the calcium group from Day 3 post-OR onwards (P<0.0001). Intravenous administration of calcium effectively prevents development of moderate or severe OHSS with no detrimental effect on the pregnancy rate, which confirms our proposed model of OHSS, in which the membrane depolarization leads to development of OHSS clinical manifestations and calcium-induced membrane stabilization is expected to alleviate OHSS symptoms.

Hypocalcemia Complicating Near-Total Thyroidectomy in Patients with Coexisting Lipid Malabsorption due to Biliopancreatic Diversion

Patients who have undergone biliopancreatic diversion (BPD) show a high incidence of mild hypocalcemia, which may become symptomatic and life-treating after an extensive thyroid operation. 4 cases are reported of women who had undergone BPD, who subsequently underwent near-total thyroidectomy for extensive multinodular goiter. The first patient developed severe symptomatic hypocalcemia with malnutrition in the long-term, that required elongation of the common limb of the BPD. The second and third patients developed severe symptomatic hypocalcemia immediately after the thyroidectomy. In the fourth patient, preventive and continuing intravenous administration of calcium gluconate was started in the early hours after the thyroidectomy and allowed a safe and fast discharge home. In patients who are candidates for both thyroid and bariatric surgery, surgeons should carefully evaluate the opportunity to perform the thyroidectomy first. BPD patients who later undergo thyroidectomy should be perioperatively routinely treated with intravenous calcium and, whenever appropriate, intravenous vitamin D, to allow a safe and rapid discharge.

Ventricular Tachycardia in a Patient with Primary Hyperparathyroidism

We present a case of primary hyperparathyroidism with hypercalcemia in a patient who had spontaneous attacks of ventricular tachycardia. Right ventricular burst pacing reproducibly induced ventricular tachycardia in the electrophysiological laboratory after intravenous administration of calcium-gluconate, and verapamil could terminate the tachycardia. After resection of the parathyroid adenoma, the calcium level was restored to normal, and ventricular tachycardia did not occur again during the follow-up period.

Techniques for evaluation of right ventricular relaxation rate in horses and effects of inhalant anesthetics with and without intravenous administration of calcium gluconate

Abstract Objectives To determine the most repeatable method for evaluating right ventricular relaxation rate in horses and to determine and compare effects of isoflurane or halothane with and without the added influence of intravenously administered calcium gluconate on right ventricular relaxation rates in horses. Animals 6 Thoroughbred horses from 2 to 4 years old. Procedure 6 models (2 for monoexponential decay with zero asymptote, 3 for monoexponential decay with variable asymptote, and 1 for biexponential decay) for determining right ventricular relaxation rate were assessed in conscious and anesthetized horses. The 2 methods yielding the most repeatable results then were used to determine right ventricular relaxation rates in horses anesthetized with isoflurane or halothane before, during, and after IV administration of calcium gluconate. Right ventricular pressure was measured, using a catheter-tip high-fidelity pressure transducer, and results were digitized at 500 Hz from minimum rate of change in ventricular pressure. Results 2 models that used monoexponential decay with zero asymptote repeatedly produced an estimate for relaxation rate and were used to analyze effects of anesthesia and calcium gluconate administration on relaxation rate. Isoflurane and halothane each prolonged right ventricular relaxation rate, with greater prolongation evident in halothane-anesthetized horses. Calcium gluconate attenuated the anesthesia-induced prolongation in right ventricular relaxation rate, with greater response obtained in isoflurane-anesthetized horses. Conclusions and Clinical Relevance Right ventricular relaxation rate in horses is assessed best by use of a monoexponential decay model with zero asymptote and nonlinear regression. Intravenous administration of calcium gluconate to isoflurane-anesthetized horses best preserves myocardial relaxant function. (Am J Vet Res 1999;60:872–879)

The influence of somatostatin on calcitonin secretion in albino rats

The effects of somatostatin on calcitonin secretion were studied in male Wistar albino rats. In anesthetized rats, the administration of synthetic somatostatin induced a reduction in the calcitonin content of the thyroid. In animals with destroyed central adrenergic neurons, the effects of somatostatin were less visible. An intravenous injection of somatostatin did not affect the baseline calcitonin level, but it did prevent the rise in calcitonin concentration elicited by the intravenous administration of calcium gluconate.

Bone agent and radiogallium deposition around infiltrated calcium gluconate.

Intravenous administration of calcium gluconate partially infiltrated the hand of a neonate. Because of subsequent redness and swelling, bone and radiogallium studies were performed. Both sets of images showed uptake in the hand crossing the wrist; there was no radiogallium excess on subtracted views. A radiograph showed calcium deposition in the hand, likely accounting for uptake of the imaging agents. The redness in the hand gradually decreased.

SYSTEMIC FLUORIDE TOXICITY IN A CHILD WITH HYDROFLUORIC ACID BURNS

We report the case of a 14-month-old child with hydrofluoric acid burns who suffered cardiac arrest in association with profound hypocalcemia and hyperfluoridemia. Successful treatment included topical, subeschar, and intravenous calcium gluconate administration.

Acute Hypercalcemia and Cardiac Autotransplantation in Dogs: Long-Term Hemodynamic Adaptability

Cardiac autotransplantation (excision and reimplantation) is a unique model that isolates totally the cardiac afferent and efferent neural pathways and results in hemodynamic misadaptability to many provocative tests. Since the cardiovascular response to acute hypercalcemia is modulated by numerous factors among which the autonomic innervation plays a major role, the hemodynamic response to bolus administration of calcium gluconate was compared in normal and cardiac autotransplanted dogs. Twenty-two animals underwent an autotransplantation while a sham procedure was performed in 18 animals. Each dog was equipped with an electromagnetic flow probe positioned around the ascending aorta and with central venous and aortic catheters. Hemodynamic data were collected daily during 1 month, before and during rapid intravenous administration of calcium gluconate (0.90 mEq). Baseline hemodynamic studies indicate that for both groups myocardial failure is evident in the immediate postoperative period; despite progressive recovery, the autotransplants always show lower cardiovascular performance. Calcium administration elicits transient positive inotropism, which is more important in presence of myocardial failure; this is true for both control and autotransplanted dogs. In the early postoperative period, hemodynamic adaptability to this stress is impaired in the autotransplants. However, long-term results indicate that minimal differences subsist over time in response to calcium administration, and when they are observed, they result from interferences in baroreceptor regulation and reflexes.

A Case of Nephrotic Syndrome With Tetany

Abstract A 7‐year‐old girl with nephrotic syndrome had several attacks of tetany during the relapses. The attacks, acccompanied by hyperventilation, responded to re‐breathing with a vinyl bag. However, other episodes of attacks which were not accompanied by hyperventilation, did not respond to re‐breathing but responded to the intravenous administration of calcium gluconate. The serum concentrations of total calcium and ionized calcium were low and no calcium‐binding protein was found in the serum from the patient, using chromatographic study. The serum concentration of 1, 25(OH)2 vitamin D was within the normal range, but showed a tendency for the value to be lower in relapse than in remission. Urinary, Ca/Cr ratio in relation to serum calcium was high in this patient and a low threshold of calcium excretion in the kidney was demonstrated.It is suggested that the impaired vitamin D metabolism and calcium loss in the urine might have contributed to tetany in this patient.Administration of a calcium preparation and vitamin D may be necessary for a frequentrelapser on long‐term glucocorticoid therapy.

Subcutaneous Calcium Deposition in the Neonate Associated With Intravenous Administration of Calcium Gluconate

Nine infants who had severe local manifestations following intravenous administration of calcium gluconate are presented. The lesions appeared at the intravenous sites as firm subcutaneous nodules or areas of areas of inflammation with central softening and fluctuation. The interval between appearance of the lesion and calcium administration was 13 plus or minus 2.5 (mean plus or minus SEM) days. Five infants were treated with antibiotics and three of the five had incision and drainage. Roentgenographic evidence of subcutaneous calcification was seen in all cases at the time the lesions were first noticed. In two infants the entire cephalic vein was calcified. Induration and inflammation completely subsided in six infants, four of whom had follow-up roentgenograms showing complete resolution of calcification. A conservative approach in management is recommended.

Metabolic balance studies of high calcium intake in osteoporosis

Positive calcium balance of varying degree has been induced by high calcium intake in four patients with frank osteoporosis and in one patient with apparently normal bone. Phosphate retention appeared to be less with calcium gluconate supplementation than with addition of dicalcium phosphate (CaHPO 4). There was often modest increase in urinary calcium but not hypercalciuria during high calcium intake, especially during calcium gluconate administration. Slow intravenous administration of calcium gluconate to one patient resulted in marked hypercalciuria. In the normal patient, who showed moderate storage of calcium during dicalcium phosphate supplementation, the laxative effect of the higher dose of calcium gluconate was associated with increased fecal calcium excretion and negative calcium balance. None of the osteoporotic patients showed definite change clinically or on roentgenograms. In view of the evidence available to date, the most likely mechanism for positive calcium balance during high intake is considered to be inhibition of bone resorption. The effect of high calcium intake upon the clinical, structural and chemical course of osteoporosis is as yet unclear. Until this is defined, no statement can be made about the etiologic role of calcium deficiency or the therapeutic usefulness of high calcium intake in osteoporosis.