Calcium gluconate in hyperkalemia???

[mpsheeha]

Does anyone know if there is any evidence as to the mechanism for cardiac stabilization using calcium gluconate in treating hyperkalemia. I am having a hard time finding any info.

Thanks!

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[Adcadet]

NMS Medicine (not at all definitive, I know) says something like "stabilizes myocardium"...I was wondering the same thing tonight.

 

[DropkickMurphy]

I believe the mechanism has to do with helping to counteract the effects of hyperkalemia on the myocardium. Perhaps it is something to do with the effect of calcium on the electrical cycle which is the opposite of that of potassium. This is just what I have been told and what I have extrapolated from it.

 

[Mumpu]

IIRC, calcium plays a role in the electrical potential immediately adjacent to the cell membrane (the environment where voltage-gated ion channels live). Increasing the gradient with gluconate infusion effectively hyperpolarizes the ion channels (but not the entire cell) which has the effect of inactivating them and reducing the arrhythmogenic badness of hyperkalemia.

 

[mpsheeha]

Thanks for the thoughts. The obvious thought is that there is play at the level of the membrane potential and I was trying to find literature to support the theory that giving calcium will actually hyperpolarize cardiac myocytes... I haven't had any success.

 

[Mumpu]

As I said in my previous post, calcium doesn't actually hyperpolarize the cells -- it acts in the microenvironment immediately adjacent to the membrane.