[Suboccipital administration of calcium gluconate].
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Verapamil is a useful drug for treating supraventricular tachycardia; however, severe side effects occasionally have been reported in infants. We describe here our experience with the use of a 10 percent solution of intravenous calcium gluconate prior to the use of verapamil in infants with paroxysmal supraventricular tachycardia. In all the attacks verapamil converted the supraventricular tachycardia to sinus rhythm. We feel that calcium gluconate injected previous to verapamil can avoid the negative inotropic effects without interfering with the antiarrhythmic properties of verapamil.
1. The action of i.v. injection of calcium gluconate on a) the release of catecholamines from the adrenals of cats and dogs, b) the adrenergic responses of circulation, nictitating membrane and spleen in cats, and c) the cardiac and circulatory response in dogs has been investigated. 2. Ca2+-effects mediated by release of catecholamines dominate in the cat, as do direct cardiac stimulating actions in the dog. 3. Ca2+-effects of therapeutic significance, if existent at all, could be assumed only with regard to an anti-anaphylactic effect of the catecholamines released by i.v. injected Ca2+.
Midtrimester abortion was succesfully induced within 30 hours in 62 out of 90 patients by intraamniotic administration of 16-phenoxy-omega-17,18,19, 20-tetranor-prostaglandine-E2-methylsulfonamide. The Pg-analogue was tested in 5 groups of patients which received 1,2 or 3 mg. In group IV, 2 mg of the analogue was combined with oxytocin. In group V, 3 mg of the analogue was combined with 2.75 grams of calcium gluconate. The success rate was significantly influenced by the amount of the drug administered. Side effects were minimal. Multiparous women respond better to the therapy than nulliparous patients. The combination with oxytocin was more effective than the Pg-analogue alone and the combination of sulprostone with calcium gluconate was 87% succesful within 30 hours and 100% succesful within 36 hours.
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Parenteral calcium may augment the degree of calcification within brains of human neonates (p less than 0.01). This observation is supported by histochemistry, atomic absorption of ashed brain, selected area diffraction, and energy dispersive microanalysis. Survival analysis indicates that a standard replacement dose may have an adverse effect of severely stressed neonates (p less than 0.01). Nuclei within the optic-tract, circumferential pons and temporal lobe showed calcium salt deposits before other cytologic evidence of necrosis was discernible. Most calcification occurred in regions of ongoing necrosis primarily in the neuropil. But Purkinje cell and supraoptic neurons and apparent neurons from the fascia dentata, Ammon's Horn, were densely calcified in several brains. In those infants surviving longer periods both the neuropil and nuclei of glial scar stained for calcium salts.
A 47-year-old woman developed postanesthesia respiratory insufficiency five hours after an intramuscular injection of 0.5 gm of kanamycin and one hour and 40 minutes after peritoneal lavage with 1.0 gm of kanamycin. The respiratory insufficiency was not reversed by an intravenous infusion of 400 mg of calcium gluconate. This is the third reported instance of respiratory insufficiency after kanamycin lavage. Only one of the previously reported patients responded to intravenous infusion of calcium gluconate, despite the experimental evidence supporting its efficacy.
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In the first part of the study 5 control subjects were submitted to iv infusion of 0.2 mM/kg of calcium gluconate in 20 min. Total calcium (atomic absorbtion method), ionized calcium (ion-selective electrode method) and adenosine (HPLC technique) were measured at the following times: 0 (baseline), 5, 10, 15, 20 (end of infusion), 25, 30, 35, and 50 min. The increase of total and ionized calcium serum levels was associated with a significant increase of adenosine plasma levels (from 207 +/- 41 to 362 +/- 63 nM, p < 0.001). Since the increase of adenosine plasma levels, obtained either with adenosine or dipyridamole (an adenosine reuptake inhibitor), has been used to test the coronary reserve in patients with coronary artery disease (CAD), in the second part of the study we compared the effects of calcium infusion with dipyridamole in 15 CAD subjects. Pharmacological stress tests were evaluated by monitoring two-dimensional echocardiography, ECG, heart rate, blood pressure and rate-pressure product. Ten patients were positive both to dipyridamole stress test and to calcium infusion, ad demonstrated by the onset of new areas of transient asynergy in the same myocardial regions. Dipyridamole infusion determined a significant increase in heart rate and rate pressure-product in all patients (both in positive and in negative), whereas calcium induced a slight, not significant decrease of these parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
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.
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A 65-years-old female patient in chronic use of verapamil who developed bradyarrhythmia and hypotension reverted by endovenous calcium gluconate.
Women with primary biliary cirrhosis malabsorb calcium, phosphate and vitamin D, and develop accelerated cortical bone thinning. We have assessed the value of parenteral vitamin D, oral hydroxyapatite (HA), and calcium gluconate (CG) in the treatment of cortical bone thinning in primary biliary cirrhosis. Sixty-four postmenopausal women with primary biliary cirrhosis were assigned randomly into three groups: one group receiving no mineral supplements (control), one group receiving HA, and one group receiving CG. All patients received parenteral vitamin D2 (100,000 IU monthly). Eleven patients withdrew from the study and 10 withdrew due to poor compliance (six HA, four CG). Over a 14-month follow-up period, none of the groups showed a significant change in serum calcium or inorganic phosphate levels. Pre- and posttreatment hand radiographs were used to assess changes in metacarpal cortical thickness using the technique of caliper radiogrammetry. Cortical bone loss occurred in the control group (p less than 0.01). The HA group showed a significant gain in cortical bone thickness (p less than 0.01), while no significant change occurred in the CG group. This study indicated that vitamin D2 does not halt metacarpal cortical bone thinning in primary biliary cirrhosis. The addition of CG prevents bone thinning, and HA promotes positive cortical bone balance.
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