Calcium chloride

[jonathan carreto]

Most common use of CaCl out on the field as a medic. Thanks guys

 

[STXmedic]

What are Calcium's indications?

 

[jonathan carreto]

Hyperkalcemia, hypocalcemia calcium channel blocker OD.

 

[DesertMedic66]

So your question is?

 

[STXmedic]

Hyperkalcemia, hypocalcemia calcium channel blocker OD.

You'll also see it with beta blocker ODs.

Now expand on hyperkalemia. Where do we run into HyperK?

 

[jonathan carreto]

Right!... Um renal failure pts.... Also Suspect hyperkalcemia with peaked t's.

 

[jonathan carreto]

Im missing something i think

 

[STXmedic]

Right!... Um renal failure pts.... Also Suspect hyperkalemia with peaked t's.

These people. There are other causes of HyperK, but we see these renal patients quite a bit. What are some reasons they become hyperkalemic, when do we often give them calcium, and why are we giving calcium? What are some other potential treatments for HyperK?

As for the ODs, in 6 years I've seen one BB overdose, and never a CCB overdose. I also do not have an iStat, and honestly probably wouldn't catch a presenting hypocalcemia patient in the field- at least not with enough certainty to want to give them any calcium. I won't likely be keeping a BP cuff inflated on their arm for 5 minutes looking for Trousseau's sign, and from what I remember, Chvotek's sign isn't all that sensitive.

 

[STXmedic]

I'm getting a bit tangental, so start ignoring me whenever you want... Lol

 

[DesertMedic66]

I'm getting a bit tangental, so start ignoring me whenever you want... Lol

Started doing that a long time ago

 

[EMTinCT]

Kidney failure=elevated K+....can lead to cardiac dysrhythmia. "I haven't peed in a week!" The theory goes that CaCl "stabilizes" the membrane potential of the cardiocytes. One cardiologist told me it was the Ca2+ ions, another told me it was the Cl- ions. Neither knew the mechanism. I have a sneaking feeling it was the Cl- ions binding to the K+ ions forming a KCl (potassium chloride, aka fake table salt, never let gramma serve this to you, yuck!) and thus reducing the free K+ that was disturbing the electrochemical gradient of the cardiocytes.

Maybe the Ca2+ ions "push" K+ back into the cell? That's how they suspect albuterol helps with K+. You can also do that nifty insulin + glucose trick. Kexelate might not work. I dunno. Hear weird things.

I might be wrong. I probably am. Don't let gramma serve you fake salt.

 

[chaz90]

Kidney failure=elevated K+....can lead to cardiac dysrhythmia. "I haven't peed in a week!" The theory goes that CaCl "stabilizes" the membrane potential of the cardiocytes. One cardiologist told me it was the Ca2+ ions, another told me it was the Cl- ions. Neither knew the mechanism. I have a sneaking feeling it was the Cl- ions binding to the K+ ions forming a KCl (potassium chloride, aka fake table salt, never let gramma serve this to you, yuck!) and thus reducing the free K+ that was disturbing the electrochemical gradient of the cardiocytes.

Maybe the Ca2+ ions "push" K+ back into the cell? That's how they suspect albuterol helps with K+. You can also do that nifty insulin + glucose trick. Kexelate might not work. I dunno. Hear weird things.

I might be wrong. I probably am. Don't let gramma serve you fake salt.

KCl is readily soluble in aqueous solutions, just like NaCl. You don't have bound salt molecules floating around in your body. Ionic bonds are no match for polar solutions.

 

[EMTinCT]

KCl is readily soluble in aqueous solutions, just like NaCl. You don't have bound salt molecules floating around in your body. Ionic bonds are no match for polar solutions.

And there's the confusion! Salts will readily dissolve in solution, so it can't be my obviously incorrect "binding" theory. The Ca2+ or the Cl- ions must be doing something. I've yet to hear what or how other than that catchall "stabilize".

Gramma isn't stable, which is why she's feeding us KCl.


NaCl
_____
NaOH

My base is under a salt. Har har har.

 

[chaz90]

The Ca2+ is generally agreed to be the active ion in the mechanism from most sources I've found. Increased extracellular positive ions (Ca2+ in this case) lead to ion gated channel opening that allows increased K+ permeability through the cell membranes and thus out of free solution.

Keep in mind that calcium gluconate can be used over calcium chloride. A lower portion of free Ca ions is available with a gluconate conjugate, but the effect can still be realized.

 

[EMTinCT]

Voltage gates ion channels or leaky channels? Aka slow or fast.

 

[chaz90]

Voltage gates ion channels or leaky channels? Aka slow or fast.

Voltage gated, since voltage is what we're altering by administering an electrolyte.

 

[EMTinCT]

Are you sure? If you get the cells up to threshold via the leaky channels then the voltage gated ones open.

 

[chaz90]

Are you sure? If you get the cells up to threshold via the leaky channels then the voltage gated ones open.

Yes? I'm not quite certain what you're asking here. You're correct that the voltage gated channels open regardless of how the potential was formed. I'm simply saying that we're not manipulating the leak channels directly by adding an electrolyte.

 

[EMTinCT]

There are two different types of ion channels that lead to depolarization- leaky (fast) and voltage gates (slow). I'm curious which channel the Ca2+ is working on.

 

[Carlos Danger]

There are two different types of ion channels that lead to depolarization- leaky (fast) and voltage gates (slow). I'm curious which channel the Ca2+ is working on.

Both.