์นผ์์ผ (๊ธ๋ฃจ์ฝ์ฐ ์นผ์, ์ผํ ์นผ์, ์ ์ฐ ์นผ์, ๊ธ๋ฃจ์ ์ฐ ์นผ์)
์นผ์์ผ์ ์ฃผ๋ก **์ ์นผ์ํ์ฆ**์ ์น๋ฃํ๊ฑฐ๋ ์๋ฐฉํ๊ณ , ์ ๋ถ์ ํ์์์ ๊ฒฝ๊ตฌ์ฉ ์ธ ๊ฒฐํฉ์ ๋ก ์ฌ์ฉ๋๋ ํ์ ๋ฏธ๋ค๋ ๋ณด์ถฉ์ ์ ๋๋ค. ์ฃผ์ฌ์ฉ ์นผ์์ ๋ค์๊ณผ ๊ฐ์ ๊ฒฝ์ฐ์ ์ฌ์ฉ๋๋ ์ค์ํ ์๊ธ ์ฝ๋ฌผ์ ๋๋ค: * **ํ์ธ๋ ์ด์จํ ์ ์นผ์ํ์ฆ** (์: ์๊ฐ์ฆ/์ฐ์๊ธฐ ํ ํ๋, ์๋ฐ์ฑ ๋ถ๊ฐ์์ ๊ธฐ๋ฅ ์ ํ์ฆ). * **๊ณ ์นผ๋ฅจํ์ฆ์ฑ ์ฌ์ฅ ๋ ์ฑ** (์: ์๋ ํ์ ๊ณ ์์ด, ์ ๋์จ ์๊ธฐ). *์์ ์์ : ์นผ์์ ํ์ฒญ ์นผ๋ฅจ ์์น๋ฅผ ๋ฎ์ถ์ง ์์ต๋๋ค. ๋์ ์ฌ๊ทผ์ ์ญ์น ์ ์๋ฅผ ๋์ฌ ์ ์์ ์ธ ํด์ง๊ธฐ-์ญ์น ๊ฐ๊ฒฉ์ ํ๋ณต์ํด์ผ๋ก์จ ์น๋ช ์ ์ธ ๋ถ์ ๋งฅ์ผ๋ก๋ถํฐ ์ฌ์ฅ์ ๋ณดํธํฉ๋๋ค.* * **์นผ์ ์ฑ๋ ์ฐจ๋จ์ ์ค๋ **. **์์ ์์ :** ์นผ์์ผ์ ๊ตฌ๋ณํ๋ ๊ฒ์ด ๋งค์ฐ ์ค์ํฉ๋๋ค. **10% ์ผํ์นผ์(Calcium chloride)**์ **10% ๊ธ๋ฃจ์ฝ์ฐ์นผ์(Calcium gluconate)**(9.3 mg/mL)์ ๋นํด ์ฝ 3๋ฐฐ ๋ง์ ์์ ์นผ์(27.2 mg/mL)์ ํจ์ ํ๊ณ ์์ต๋๋ค. ์ผํ์นผ์์ ์๊ทน์ฑ์ด ๊ฐํ๊ณ ์ฐ์ฑํ ์์ฉ์ ํ๋ฉฐ, ํ๊ด ์ธ๋ก ์ ์ถ๋ ๊ฒฝ์ฐ ์ฌ๊ฐํ ์กฐ์ง ๊ดด์ฌ์ ์ํ์ด ์์ผ๋ฏ๋ก ์ด์์ ์ผ๋ก๋ ์ค์ฌ ์ ๋งฅ๊ด์ ํตํด ํฌ์ฌํด์ผ ํฉ๋๋ค. ๋ง์ด ์ ๋งฅ ํฌ์ฌ ์์๋ ๊ธ๋ฃจ์ฝ์ฐ์นผ์์ด ์ ํธ๋ฉ๋๋ค.
์์ฉ ๊ธฐ์ : Calcium is an essential intracellular and extracellular cation vital for numerous physiological processes: * **Nervous and Musculoskeletal Function:** Facilitates excitation-contraction coupling in cardiac and smooth muscle, and is required for neurotransmitter release at synaptic clefts. * **Cell Membrane Permeability:** Maintains cell membrane integrity and capillary permeability. * **Enzymatic Reactions:** Acts as a crucial cofactor for various enzymatic reactions and the coagulation cascade. * **Hyperkalemia Antagonism:** In hyperkalemia, elevated resting membrane potentials lead to cardiac conduction blocks. Calcium administration **โ** raises the threshold potential **โ** restores the normal electrical gradient **โ** stabilizes the myocardium.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Hypocalcemia ยท 150-250 mg/kg IV slowly to effect ยท IV ยท PRN ยท Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
- Hypocalcemia ยท Calcium gluconate 23% injection: 25-50 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) ยท IV/IM/SC ยท PRN
- Hypocalcemia ยท 150-250 mg/kg IV slowly to effect ยท IV ยท PRN ยท Dosing extrapolated from sheep guidelines. Intraperitoneal route may also be used.
- Hypocalcemia ยท Calcium gluconate 23% injection: 25-50 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) ยท IV/IM/SC ยท PRN ยท Dosing extrapolated from sheep guidelines.
- Hypocalcemia ยท 94-140 mg/kg IV slowly to effect ยท IV ยท PRN ยท Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
- Acute hypocalcemia secondary to hypoparathyroidism ยท 10% calcium gluconate injection, give 1-1.5 mL/kg IV slowly over 10-20 minutes. Once controlled, add to IV fluids as slow infusion at 60-90 mg/kg/day (of elemental calcium) [converts to 2.5 mL/kg every 6-8 hours of 10% calcium gluconate]. Oral: initially 50-100 mg/kg/day divided 3-4 times daily of elemental calcium. ยท IV/PO ยท PRN/CRI/Divided ยท Monitor ECG. If bradycardia or Q-T interval shortening occurs, slow rate or temporarily discontinue.
- Hypocalcemia secondary to phosphate enema toxicity or puerperal tetany ยท 10% calcium gluconate injection, give 1-1.5 mL/kg IV slowly over 10-20 minutes. ยท IV ยท PRN ยท Follow guidelines for use of intravenous calcium.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Ventricular fibrillation
- Hypercalcemia
์ด์๋ฐ์
- Hypercalcemia
- GI irritation and/or constipation (oral administration)
- Mild to severe tissue reactions, pyogranulomatous panniculitis, adipocyte mineralization (IM or SC administration)
- Venous irritation (IV administration)
- Hypotension (if given IV too rapidly)
- Cardiac arrhythmias and cardiac arrest (if given IV too rapidly)
์ฝ๋ฌผ ์ํธ์์ฉ
- Calcium Channel Blockers (e.g., diltiazem, verapamil) ยท Intravenous calcium may antagonize the effects of calcium-channel blocking agents.
- Digoxin ยท Patients on digitalis therapy are more apt to develop arrhythmias if receiving IV calcium; use with extreme caution.
- Magnesium (oral) ยท May lead to increased serum magnesium and/or calcium, particularly in patients with renal failure.
- Magnesium Sulfate (parenteral) ยท Parenteral calcium can neutralize the effects of hypermagnesemia or magnesium toxicity secondary to parenteral magnesium sulfate.
- Neuromuscular Blockers (e.g., atracurium, vecuronium, tubocurarine) ยท Parenteral calcium may reverse the effects of nondepolarizing neuromuscular blocking agents; has been reported to prolong or enhance the effects of tubocurarine.
- Tetracyclines, Fluoroquinolones (oral) ยท Oral calcium can reduce the amount of these antibiotics absorbed from the GI tract via chelation; separate dosages by at least two hours.
- Potassium Supplements ยท Patients receiving both parenteral calcium and potassium supplementation may have an increased chance of developing cardiac arrhythmias.
- Thiazide Diuretics ยท Used in conjunction with large doses of calcium may cause hypercalcemia.
- Vitamin A ยท Excessive intake may stimulate calcium loss from bone and cause hypercalcemia.
- Vitamin D ยท Concurrent use of large doses of vitamin D or its analogs may cause enhanced calcium absorption and induce hypercalcemia.
๋ชจ๋ํฐ๋ง
- Serum calcium (total and ionized)
- Serum magnesium, phosphate, and potassium
- Serum PTH (parathormone) if indicated
- Renal function tests
- ECG and heart rate (continuously during IV therapy)
- Urine calcium (if hypercalciuria develops)
๊ณผ์ฉ๋
Oral overdoses of calcium-containing products are unlikely to cause hypercalcemia unless other drugs (e.g., Vitamin D) are given concurrently that enhance absorption. **Hypercalcemia** can occur with parenteral therapy or oral therapy combined with Vitamin D or increased PTH levels. * **Mild hypercalcemia:** Generally resolves without intervention when renal function is adequate. Withhold calcium therapy and Vitamin D analogs. * **Serious hypercalcemia (>12 mg/dL):** Treat by hydrating with IV normal saline and administering a loop diuretic (e.g., **furosemide**) to increase sodium and calcium excretion. Monitor and replace potassium and magnesium as necessary. Monitor ECG. Corticosteroids, calcitonin, and hemodialysis may also be employed.
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