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Micronutrients
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
The use of calcium supplements in tablet form is controversial because their efficacy largely depends on their water-solubility. Calcium citrate and lactate are water-soluble, contrary to calcium carbonate and phosphate. The first ones are more absorbed by the intestinal tract than calcium carbonate and phosphate, hence their efficacy is higher than that of carbonate and phosphate. Ca with vitamin D3 supplement is also used to treat some bone diseases. Calcium gluconate is the calcium salt of gluconic acid. It is easily water-soluble and used as an intravenous medication for the treatment of some diseases such as tetany and hypoparathyroidism due to calcium deficiency, and hypocalcemia due to pregnancy or rapid growth of skeleton. The use of Ca supplements also varies between countries. In the United States and Canada, around 40% of the adult population was reported to have taken Ca supplements, and 70% in the older women group (10). In contrast, in Argentina and in Europe, very few people are reported taking Ca supplements, even during pregnancy. This difference is mainly due to the habitude of each population rather than due to the lack of Ca in their diet because both populations have similar diets (10).
Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Renal dosing of medications filtered and/or excreted by the kidneys (i.e., magnesium sulfate, antibiotics). Magnesium is not contraindicated, but should be used with extreme caution, begun at 1 to 2 g/hour, possibly without a bolus, or just giving boluses (no continuous infusion rate) as needed. Evaluation for side effects of magnesium should occur at least hourly and magnesium levels should be checked often (e.g., every 2–4 hours) in labor to adjust the dose. Calcium gluconate should be available. Clinicians should be aware of the increased risk of pulmonary edema in women with CKD and pre-eclampsia [27].
Neonatal Seizures
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
If hypocalcemia is present (<7 mg/dl), a slow infusion of 5% calcium gluconate (4 to 5 ml/kg) is given with EKG monitoring. Oral calcium gluconate (400 mg/kg/day) is given for maintenance. With the concomitant or rarely isolated hypomagnesemia a solution of 2 to 3% magnesium sulfate is infused (2 to 8 cc). Some advocate an intramuscular injection of a 50% solution (0.2 mg/kg). Levels of serum Mg should be monitored to avoid its potential curarelike effect. If hypoglycemia is present, 4 to 6 mg/kg of a 20 to 30% dextrose solution can be given rapidly i.v., followed by maintenance dextrose infusion of up to 0.5 g/kg/hr, to obtain moderately high levels of glucose, but avoiding overhydration. Although very rare, pyridoxine dependency can be diagnosed only by the clinical-electrical effects following a large dose of pyridoxine, namely 50 to 100 mg that should be injected i.v. or i.m. before AEDs. The maintenance dose is 5 to 10 mg/day, though some report the need for larger amounts. In our experience the dependency persists through life.
A rare case of spontaneous tumor lysis syndrome in multiple myeloma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Louay Aldabain, Lyn Camire, David S. Weisman
For the treatment of established TLS, the expert consensus panel recommended hydration with IV fluids at approximately 3 L/m2 every 24 h to maintain a urine output of 80 to 100 mL/m2/h [12]. Diuretics may be considered in euvolemic patients to augment urine output, but they are contraindicated in patients with hypovolemia or obstructive uropathy. Alkalinization with sodium bicarbonate must be individualized. The panel recommended treatment with rasburicase over allopurinol for patients with preexisting hyperuricemia (≥ 450 μmol/L or 7.5 mg/dL), with a dose of 0.15 to 0.2 mg/kg once daily in 50 mL of normal saline as an IV infusion over 30 minutes for 5 days [12]. Patients should be on a cardiac monitor with close follow-up of electrolyte levels. Hyperkalemia should be managed based on standard treatment. Asymptomatic patients with hypocalcemia require no treatment. Symptomatic patients may be treated with calcium gluconate 50 to 100 mg/kg IV, administered slowly. Hyperphosphatemia can be managed with adequate hydration and phosphate binders. For severe hyperphosphatemia, hemodialysis is preferred to peritoneal dialysis or continuous venovenous hemofiltration [12]. Hemodialysis is also indicated for persistent hypokalemia, hypocalcemia, hyperuricemia, or volume overload [12,13].
Ocular Findings Associated with Hypoparathyroidism
Published in Ocular Immunology and Inflammation, 2021
Nurdan Gamze Taşlı, Emin Murat Akbaş
Hypoparathyroidism was defined as the documented PTH levels below the lower limit (serum PTH levels <11.2 pg/mL) the normal range at least two times, in the presence of hypocalcemia (serum calcium levels <8.6 mg/dL).6 All patients diagnosed with hypoparathyroidism were treated with calcium carbonate (1–3 g/day) and calcitriol (0.5–1.5 μg/day) even if they were asymptomatic. Intravenous calcium gluconate was given in only patients with severe symptoms. In all patients, thyroid hormones were at normal levels, and all patients who had thyroid operation were under thyroid hormone replacement treatment.
Magnesium intoxication in women with preeclampsia with severe features treated with magnesium sulfate
Published in Hypertension in Pregnancy, 2020
Muhammad Ilham Aldika Akbar, Daniel Yoseph, Aditiawarman -, Muhammad Adrianes Bachnas, Erry Gumilar Dachlan, Gustaaf Albert Dekker
All patients in the Mg intoxicated group received calcium gluconate therapy as immediate management in line with our national protocol. This routine intervention is not found in the large systematic review by Lowe et al. The use of calcium gluconate in their review was extremely rare (0.18%). There is no clear explanation of this finding. However, Lowe et al. assumed that the low use of calcium gluconate reflects an infrequent need for its use as an antidote, rather than the unavailability of the drugs in the hospital (8,24).