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Step II Calcium gluconate
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According to Cleveland Clinic, it's hyperkalemia. They explicate the Txs for hyper- and hypokalemia, but calcium gluconate is only listed for hyper-.
http://www.clevelandclinicmeded.com...ment/nephrology/hypokalemia-and-hyperkalemia/
http://www.clevelandclinicmeded.com...ment/nephrology/hypokalemia-and-hyperkalemia/
Clinically, I have never seen anyone give calcium gluconate for hypokalemia.
One would think mechanistically it would work for either, but I've only seen it used for hyperK
One would think mechanistically it would work for either, but I've only seen it used for hyperK
No, it doesn't work for both.
"Normally the cardiac myocyte has a resting membrane potential(RMP is -90mV) and a threshold potential at which it is excited(TP is-75mV).So a 15mV depolarisation is needed to excite the myocyte. In hyperkalemia, the RMP becomes less negative (-80mV) , but the TP remains at -75mV. This means that ..now..only a 5mV depolarisation is enough to excite the myocyte. This is the cause of hyperexcitability leading to arrhythmia.Calcium gluconate...by increasing Ca transport across the membrane reduces the TP from -75mV to around -65mV ...restoring the 15mV depolarisation needed to excite the myocyte. (the numbers in mV are just an example)." ...... Annals of Emer Med 2011
You're basically giving the calcium to increase the positive charge in the cell because there isn't anything else that will raise it with lesser risk. But you've gotta watch out giving calcium gluconate to someone taking digoxin. Apparently in that case the calcium gluconate is reserved for hyperkalemia associated with loss of p waves and widening of the QRS (i.e., you wouldn't just give it cuz the t waves are spiked).
"Normally the cardiac myocyte has a resting membrane potential(RMP is -90mV) and a threshold potential at which it is excited(TP is-75mV).So a 15mV depolarisation is needed to excite the myocyte. In hyperkalemia, the RMP becomes less negative (-80mV) , but the TP remains at -75mV. This means that ..now..only a 5mV depolarisation is enough to excite the myocyte. This is the cause of hyperexcitability leading to arrhythmia.Calcium gluconate...by increasing Ca transport across the membrane reduces the TP from -75mV to around -65mV ...restoring the 15mV depolarisation needed to excite the myocyte. (the numbers in mV are just an example)." ...... Annals of Emer Med 2011
You're basically giving the calcium to increase the positive charge in the cell because there isn't anything else that will raise it with lesser risk. But you've gotta watch out giving calcium gluconate to someone taking digoxin. Apparently in that case the calcium gluconate is reserved for hyperkalemia associated with loss of p waves and widening of the QRS (i.e., you wouldn't just give it cuz the t waves are spiked).
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