Calcium gluconate 544mg/5ml / Calcium lactate 276mg/5ml oral solution

IntroductionIntravenous (IV) fluid therapy plays a vital role in modern medical practice, particularly in critical care management. This review aims to summarize the composition, indications, and contraindications of IV fluids, serving as a useful resource for healthcare professionals.MethodsReview of the literature published in MEDLINE using PubMed and Web of Science, between 2009 and 2024. Systematic reviews, meta-analyses, expert reviews, and guidelines were preferred for analysis.ResultsIV fluids can be administered for various reasons, including resuscitation, correction of electrolyte imbalances, or more critical cases. They can be divided into 2 categories: crystalloids and colloids. Crystalloids, in turn, can be subdivided into unbalanced solutions, such as salines (0.45%, 0.9%, 3%, and 20%) and dextrose 5%, or balanced solutions, such as Ringer lactate and polyelectrolytic solutions. Colloids can be derived from plasma, such as 5% albumin, or semisynthetic, such as 4% modified fluid gelatin. Crystalloids are generally more cost-effective, have a lower risk of allergic reactions, and are more readily available than colloids. However, the use of each solution should be individualized based on the patient's specific needs and corresponding conditions.ConclusionsIt is essential to have a thorough understanding of available IV fluid solutions to select the best option for each patient's condition at any given time. This review summarizes the most relevant information to guide these decisions. Future research should develop IV fluids that combine the benefits of colloids and crystalloids for safer, more personalized, and cost-effective treatments.

Abstract licence: CC BY-NC-ND

ObjectiveRegional citrate anticoagulation (RCA) is recommended as the first choice of anticoagulation strategies in continuous renal replacement therapy (CRRT). However, when using calcium-containing replacement fluid, whether RCA can achieve sufficient anticoagulant effect among different CRRT modalities remains unclear.Materials and methodsIn this open-label, three-arm, randomized trial, AKI patients receiving RCA-CRRT with calcium-containing replacement fluids were randomized to continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF) groups from 2022 to 2023. The primary outcomes were circuit lifespan and early circuit failure. Secondary endpoints included the safety of the three groups and 30-day all-cause mortality.ResultsA total of 121 patients were enrolled, with 40 in CVVH group, 40 in CVVHD group, and 41 in CVVHDF group. The circuit lifespan in CVVHDF group (70 h, IQR 65-72) was significantly longer than that in CVVHD (47 h, IQR 31.5-54) and CVVH group (64 h, IQR 46-71) (P ConclusionOur findings suggested that RCA-CRRT with calcium-containing replacement solution appeared to be safe and effective, with CVVHDF showing potentially prolonged filter survival compared to alternative modalities, which might support its consideration as a possible option in clinical practice.Trial registrationThis study was registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) under the registration number ChiCTR2200061065 on 15 June 2022.

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Fluoroacetamide, a commonly used convulsant rodenticide, can rapidly damage the nervous, digestive, and cardiovascular systems, potentially leading to fatal outcomes if ingested. This study reports the case of a 62-year-old Chinese woman who presented with symptoms of intoxication, including slurred speech, agitation, and seizure-like episodes, accompanied by gastrointestinal symptoms such as vomiting, skin bruising, and mild liver dysfunction. Toxin analysis revealed the presence of fluoroacetate in her blood and urine, and diffusion weighted imaging (DWI) imaging indicated white matter lesions, leading to the diagnosis of rare fluoroacetamide poisoning. This diagnosis facilitated the administration of treatments including vitamin K, hemodialysis, acetamide, and calcium gluconate. The patient subsequently regained consciousness, with improvements in laboratory results and gradual resolution of toxic-metabolic encephalopathy. This case highlights the importance of considering drug poisoning in patients with challenging neurological symptoms, particularly when there is a potential history of drug ingestion. Accurate diagnosis of such conditions is crucial, as timely and appropriate treatment can significantly improve clinical outcomes.

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Calcium plays an essential role in myocardial contractility, excitation-contraction coupling, and vascular tone. In cardiothoracic surgery, calcium supplementation is frequently administered during weaning from cardiopulmonary bypass (CPB) and in the early postoperative period to support haemodynamics. Despite its widespread use, the evidence base underpinning this practice remains limited and inconsistent. This narrative review explores the physiological rationale for calcium supplementation in the cardiothoracic surgical population, synthesises existing experimental and clinical data, and considers potential benefits and risks relevant to contemporary intensive care practice. Animal models suggest that calcium desensitisation contributes to myocardial dysfunction following hypothermic circulatory arrest, with supplementation theoretically improving contractility. In human studies, calcium administration during CPB weaning or in the immediate post-CPB period has been associated with transient increases in mean arterial pressure, systemic vascular resistance and left ventricular stroke work index. However, these effects are short-lived and data beyond the early postoperative phase remains limited. Potential risks of calcium supplementation include exacerbation of ischaemia-reperfusion injury, arrhythmogenesis, graft vasospasm, and tissue injury related to extravasation. The absence of specific guideline recommendations, in contrast to established consensus for vasopressor therapy, likely contributes to international variability in practice. Most studies are small, dated, or proof-of-concept and no high-quality randomised controlled trials have examined patient-centred outcomes such as vasopressor duration, organ dysfunction, or length of stay. Further multicentre observational and target-trial emulation studies are warranted to clarify the role of ionised calcium use in contemporary perioperative and intensive care practice.

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Dental erosion has emerged as a significant modern oral health problem, characterized by the chemical dissolution of tooth structure resulting from frequent exposure to intrinsic or extrinsic acids. With a high global prevalence ranging from 30% to 50% in children and 20% to 40% in adults, its management is a clinical priority to prevent long-term complications like dentine hypersensitivity and functional impairment. This review outlines the multifactorial etiology of erosion, encompassing dietary acids, gastroesophageal reflux, and reduced salivary flow. The historical context of oral care is explored, leading to a discussion on contemporary management strategies centered on remineralization. Fluoride ions play a crucial role by inhibiting demineralization, facilitating the formation of acid-resistant fluorapatite, and exerting antibacterial effects. A major focus is placed on advanced biomimetic, calcium phosphate-based topical agents such as Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), functionalized Tricalcium Phosphate (fTCP), and Hydroxyapatite (HAP), which effectively replenish lost minerals. The review further explores innovative methods, such as laser-assisted and electrically enhanced remineralization. Finally, it outlines next-generation regenerative strategies, including self-assembling peptides (P11-4), stem cell therapies, 3D bioprinting, and gene-editing (CRISPR) technologies, which aim to biologically regenerate lost enamel and dentine. The field is rapidly evolving from a preventive to a restorative paradigm, with future directions focusing on biologically based, minimally invasive therapies to fully restore tooth structure and function.

Abstract licence: CC BY