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==Background== | ==Background== | ||
*Administration of intravenous calcium thought to be contraindicated in patients with [[Digoxin Toxicity| | *Administration of intravenous [[calcium chloride|calcium]] thought to be contraindicated in patients with [[Digoxin Toxicity|digitalis toxicity]] based on 1936 case report<ref>Bower JO ,Mengle HAK. The additive effect of calcium and digitalis. JAMA 1936;106(14):1151–1153.</ref> | ||
*It was theorized in case report that calcium may cause an irreversible non-contractile state by impairing diastolic relaxation from calcium-[[troponin]] C binding in the presence of Na/K channel blockade by Digoxin<ref>Erickson CP, Olson KR. Case files of the medical toxicology fellowship of the California poison control system-San Francisco: calcium plus digoxin-more taboo than toxic? J Med Toxicol. 2008;4(1):33-39. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550094/pdf/13181_2009_Article_BF03160949.pdf FullText]</ref> | *It was theorized in case report that calcium may cause an irreversible non-contractile state by impairing diastolic relaxation from calcium-[[troponin]] C binding in the presence of Na/K channel blockade by Digoxin<ref>Erickson CP, Olson KR. Case files of the medical toxicology fellowship of the California poison control system-San Francisco: calcium plus digoxin-more taboo than toxic? J Med Toxicol. 2008;4(1):33-39. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550094/pdf/13181_2009_Article_BF03160949.pdf FullText]</ref> | ||
*Excess calcium may also predispose to arrhythmias by adversely affecting re-polarization | *Excess calcium may also predispose to [[arrhythmias]] by adversely affecting re-polarization | ||
==Current Literature== | ==Current Literature== | ||
*Patients with digoxin toxicity who | *Patients with digoxin toxicity who given calcium do not have a statistically significant increase in mortality (22% versus 20%)<ref>Levine M, Nikkanen H, Pallin DJ. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg Med. 2011 Jan;40(1):41-6 [http://www.emergencymedicine.utoronto.ca/Assets/EmergeMed%20Digital%20Assets/event/Journal%20Club/The%20Effects%20of%20Intravenous%20Calcium%20in%20Patients%20with%20Digoxin%20Toxicity.pdf FullText]</ref> | ||
*A 2003 case report describes positive benefit from treating hyperkalemia in the setting of digitalis toxicity<ref>Van Deusen SK, et al. Treatment of hyperkalemia in a patient with unrecognized digitalis toxicity J Toxicol Clin Toxicol 2003;41:373-376.</ref> | *A 2003 case report describes positive benefit from treating hyperkalemia in the setting of digitalis toxicity<ref>Van Deusen SK, et al. Treatment of hyperkalemia in a patient with unrecognized digitalis toxicity J Toxicol Clin Toxicol 2003;41:373-376.</ref> | ||
Latest revision as of 17:00, 26 September 2019
Background
- Administration of intravenous calcium thought to be contraindicated in patients with digitalis toxicity based on 1936 case report[1]
- It was theorized in case report that calcium may cause an irreversible non-contractile state by impairing diastolic relaxation from calcium-troponin C binding in the presence of Na/K channel blockade by Digoxin[2]
- Excess calcium may also predispose to arrhythmias by adversely affecting re-polarization
Current Literature
- Patients with digoxin toxicity who given calcium do not have a statistically significant increase in mortality (22% versus 20%)[3]
- A 2003 case report describes positive benefit from treating hyperkalemia in the setting of digitalis toxicity[4]
External Links
See Also
References
- ↑ Bower JO ,Mengle HAK. The additive effect of calcium and digitalis. JAMA 1936;106(14):1151–1153.
- ↑ Erickson CP, Olson KR. Case files of the medical toxicology fellowship of the California poison control system-San Francisco: calcium plus digoxin-more taboo than toxic? J Med Toxicol. 2008;4(1):33-39. FullText
- ↑ Levine M, Nikkanen H, Pallin DJ. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg Med. 2011 Jan;40(1):41-6 FullText
- ↑ Van Deusen SK, et al. Treatment of hyperkalemia in a patient with unrecognized digitalis toxicity J Toxicol Clin Toxicol 2003;41:373-376.