Calcium gluconate

Calcium gluconate
Names
IUPAC name
calcium (2R,3S,4R,5R)- 2,3,4,5,6-pentahydroxyhexanoate
Identifiers
299-28-5 YesY
ChemSpider 8932 YesY
Jmol interactive 3D Image
PubChem 9290
UNII SQE6VB453K YesY
Properties
C12H22CaO14
Molar mass 430.373 g/mol
Appearance powder
Odor odorless
Melting point 120 °C (248 °F; 393 K) (decomposes)
slowly soluble
Solubility insoluble in alcohol and organic solvents
Acidity (pKa) 6-7
Pharmacology
ATC code A12AA03
D11AX03
Hazards
NFPA 704
Flammability code 1: Must be pre-heated before ignition can occur. Flash point over 93 °C (200 °F). E.g., canola oil Health code 1: Exposure would cause irritation but only minor residual injury. E.g., turpentine Reactivity code 0: Normally stable, even under fire exposure conditions, and is not reactive with water. E.g., liquid nitrogen Special hazards (white): no codeNFPA 704 four-colored diamond
1
1
0
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
YesY verify (what is YesYN ?)
Infobox references

Calcium gluconate is a mineral supplement. It is manufactured by the neutralization of gluconic acid with lime or calcium carbonate.

It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.[1]

Medical uses

Hypocalcemia

10% calcium gluconate solution (given intravenously) is the form of calcium most widely used in the treatment of hypocalcemia. This form of calcium is not as well absorbed as calcium lactate,[2] and it only contains 0.93% (930 mg/dl) calcium ion (defined by 1 g weight solute dissolved in 100 ml solvent to make 1% solution w/v). Therefore, if the hypocalcaemia is acute and severe, calcium chloride is given instead.

Magnesium sulfate overdose

It is also used to counteract an overdose of Epsom Salts magnesium sulfate,[3] which is often administered to pregnant women in order to prophylactically prevent seizures (as in a patient experiencing preeclampsia). Magnesium sulfate is no longer given to pregnant women who are experiencing premature labor in order to slow or stop their contractions (other tocolytics are now used instead due to better efficacy and side effect profiles). Excess magnesium sulfate results in magnesium sulfate toxicity, which results in both respiratory depression and a loss of deep tendon reflexes (hyporeflexia). Calcium gluconate is the antidote for magnesium sulfate toxicity.

HF burns

Gel preparations of calcium gluconate are used to treat hydrofluoric acid burns.[4][5] This is because calcium gluconate reacts with hydrofluoric acid to form insoluble, non-toxic calcium fluoride.

Hyperkalemia

Calcium gluconate is used as a cardioprotective agent in hyperkalemia, with one alternative being use of calcium chloride.[6] Though it does not have an effect on potassium levels in the blood, it reduces the excitability of cardiomyocytes thus lowering the likelihood of developing cardiac arrhythmias.[7]

Black Widow Spider Bites

Historically, IV calcium gluconate was used as an antidote for black widow spider envenomation, often in conjunction with muscle relaxants.[8] This therapy, however, has since been shown to be ineffective.[9][10]

Side effects

Calcium gluconate side effects include nausea, constipation, upset stomach. Rapid intravenous injections of calcium gluconate may cause hypercalcaemia, which can result in vasodilation, cardiac arrhythmias, decreased blood pressure, and bradycardia. Extravasation of calcium gluconate can lead to cellulitis. Intramuscular injections may lead to local necrosis and abscess formation.[11]

It is also reported that this form of calcium increases renal plasma flow, diuresis, natriuresis,[12][13] glomerular filtration rate,[14] and prostaglandin E2 and F1-alpha levels.[15]

Society and culture

Shortages of medical calcium gluconate were reported in November 2012 and November 2015 in the United States.[6][16]

References

  1. ↑ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  2. ↑ Spencer, H.; Scheck, J.; Lewin, I.; Samachson, J. (1966). "Comparative absorption of calcium from calcium gluconate and calcium lactate in man". The Journal of Nutrition 89 (3): 283–292. PMID 4288031.
  3. ↑ Omu AE, Al-Harmi J, Vedi HL, Mlechkova L, Sayed AF, Al-Ragum NS (2008). "Magnesium sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait". Med Princ Pract 17 (3): 227–32. doi:10.1159/000117797. PMID 18408392.
  4. ↑ el Saadi MS, Hall AH, Hall PK, Riggs BS, Augenstein WL, Rumack BH (1989). "Hydrofluoric acid dermal exposure". Vet Hum Toxicol 31 (3): 243–7. PMID 2741315.
  5. ↑ Roblin I, Urban M, Flicoteau D, Martin C, Pradeau D (2006). "Topical treatment of experimental hydrofluoric acid skin burns by 2.5% calcium gluconate". J Burn Care Res 27 (6): 889–94. doi:10.1097/01.BCR.0000245767.54278.09. PMID 17091088.
  6. 1 2 Faine; Miller (December 2013). "The Calcium Quandry". Emergency Physicians Monthly. Retrieved 20 November 2015.
  7. ↑ Parham, W. A.; Mehdirad, A. A.; Biermann, K. M.; Fredman, C. S. (2006). "Hyperkalemia revisited". Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 33 (1): 40–47. PMC 1413606. PMID 16572868.
  8. ↑ Pestana, Carlos Dr. Pestana Surgery Notes Kaplan Medical 2013
  9. ↑ Offerman, Steven (2011). "The Treatment of Black Widow Spider Envenomation with Antivenin Latrodectus Mactans: A Case Series". The Permanente Journal 15: 76–81. PMC 3200105. PMID 22058673.
  10. ↑ Clark, Richard (July 1992). "Clinical presentation and treatment of black widow spider envenomation: A review of 163 cases". Annals of Emergency Medicine 21: 782–787. doi:10.1016/S0196-0644(05)81021-2. Retrieved 2014-08-09.
  11. ↑ Yui-Ming Lam, Hung-Fat Tse, Chu-Pak Lau (April 2001). "Continuous Calcium Chloride Infusion for Massive Nifedipine Overdose". Chest 119 (4): 1280–1282. doi:10.1378/chest.119.4.1280. PMID 11296202.
  12. ↑ Ruilope LM, Oliet A, Alcázar JM, Hernández E, Andrés A, Rodicio JL, García-Robles R, Martínez J, Lahera V, Romero JC. (December 1989). "Characterization of the renal effects of an intravenous calcium gluconate infusion in normotensive volunteers.". J Hypertens Suppl. 7 (6): 170. doi:10.1097/00004872-198900076-00081. PMID 2632708.
  13. ↑ Bernardi M, Di Marco C, Trevisani F, Fornalè L, Andreone P, Cursaro C, Baraldini M, Ligabue A, Tamè MR, Gasbarrini G. (July 1993). "Renal sodium retention during upright posture in preascitic cirrhosis.". Gastroenterology. 105 (1): 188–193. PMID 8514034.
  14. ↑ Wong F, Massie D, Colman J, Dudley F. (March 1993). "Glomerular hyperfiltration in patients with well-compensated alcoholic cirrhosis.". Gastroenterology. 104 (3): 884–900. PMID 8440439.
  15. ↑ Lahera V, Fiksen-Olsen MJ, Romero JC. (February 1990). "Stimulation of renin release by intrarenal calcium infusion.". Hypertension 15 (2): 149–152. doi:10.1161/01.hyp.15.2_suppl.i149. PMID 2404858.
  16. ↑ "FDA Drug Shortages". www.accessdata.fda.gov. Retrieved 2015-11-21.

See also

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