Calcium lactate gluconate 2.263g / Calcium carbonate 1.75g effervescent tablets sugar free

BackgroundHypocalcemia is common among patients admitted to the intensive care unit (ICU). The administration of calcium in critically ill patients with hypocalcemia remains debated, as previous data on outcomes are conflicting, and subgroup analyses are lacking. This study aimed to investigate the association between parenteral calcium administration and clinical outcomes in critically ill patients who had hypocalcemia with and without sepsis.MethodsThis retrospective cohort study included individuals who developed hypocalcemia during the first 7 days of admission to a mixed medical-surgical adult ICU at a University-affiliated teaching hospital. Patients who were not receiving renal replacement therapy, and were admitted to the ICU for at least 48 h between October 1, 2015 and September 24, 2020, were included. The primary outcomes included all-cause 180-day mortality and time-to-shock resolution. Subgroup analyses were conducted in sepsis and nonsepsis patients with mild or moderate hypocalcemia, based on median splits. Proportional hazard regression analyses were performed to identify the association between parenteral calcium administration and outcome parameters.ResultsAmong the 1100 patients who met the inclusion criteria, 427 (38.8 %) patients were admitted for sepsis and 576 (52.4 %) patients received parenteral calcium. Patients who received and did not receive parenteral calcium demonstrated no significant difference in 180-day mortality (adjusted hazard ratio [aHR] = 1.18, 95 % confidence interval [CI]: 0.90 to 1.56). Intravenous calcium administration reduced the probability of a shorter time to shock resolution (adjusted odds ratio = 0.81, 95 % CI: 0.70 to 0.94). Subgroup analyses in patients with and without sepsis indicated no significant association between calcium administration (aHR = 1.63, 95 % CI: 0.99 to 2.69) and 180-day mortality (aHR = 1.06, 95  % CI: 0.74 to 1.51). Notably, parenteral calcium was associated with an elevated risk of 90- and 180-day mortality in patients who had sepsis and mild hypocalcemia (aHR = 1.88, 95 % CI: 1.02 to 3.47 and aHR = 1.79, 95 % CI: 1.07 to 3.00, respectively).ConclusionsIntravenous calcium administration did not provide survival or shock resolution benefits in ICU patients with hypocalcemia, and may even be harmful. Further research, including randomized controlled trials, are needed to confirm these findings.

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BackgroundBalanced crystalloid solutions may improve clinical outcomes compared with saline for some critically ill adults, but it is unclear whether differences in composition between balanced crystalloid solutions affect outcomes.Research questionDoes the choice of balanced crystalloid solutions (Normosol-R vs lactated Ringers) impact acid-base status, organ function, or outcomes for critically ill adults?Study design and methodsThis pragmatic, cluster-randomized, multiple-crossover trial at an academic medical center in the United States compared the use of Normosol-R vs lactated Ringers among critically ill adults. The primary outcome was the plasma bicarbonate (HCO3-) concentration between enrollment and 7 days. Secondary outcomes included receipt of kidney replacement therapy and death by day 30.ResultsBetween June 1, 2018, and January 31, 2019, 2,084 patients were enrolled. The median age was 59 years, 1,006 patients (48.3%) were female, and the median Sequential Organ Failure Assessment score was 5 (interquartile range, 3-8). HCO3- concentration between enrollment and 7 days did not differ between the Normosol-R and lactated Ringers groups (mean difference, -0.12 mmol/dL; 95% CI, -0.61 to 0.36; P = .61). A total of 58 patients (6.0%) in the Normosol-R group and 47 patients (5.0%) in the lactated Ringers group received new kidney replacement therapy (absolute risk difference, 1.0%; 95% CI, -1.2% to 3.1%). Death by day 30 occurred in 172 patients (16.3%) in the Normosol-R group and 164 patients (16.0%) in the lactated Ringers group (absolute risk difference, 0.3%; 95% CI, -2.9% to 3.6%).InterpretationAmong critically ill adults, the use of Normosol-R for IV fluid therapy did not affect plasma HCO3- concentrations or clinical outcomes compared with lactated Ringers.Clinical trial registrationClinicalTrials.gov; No.: NCT03537898; URL: www.Clinicaltrialsgov.

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PurposeAutosomal Dominant Hypocalcemia type 1 (ADH1), caused by gain-of-function variants in the calcium-sensing receptor (CASR), is characterized by a variable degree of hypocalcemia and hypercalciuria with inappropriately low PTH. The clinical spectrum is broad, ranging from being asymptomatic to presenting with severe clinical features of hypocalcemia and end-organ damage such as nephrolithiasis and intracerebral calcifications. Although the underlying pathophysiology is different, ADH1 patients are often managed as patients with 'classical' primary hypoparathyroidism, possibly leading to (exacerbation of) hypercalciuria. New treatments such as PTH analogues and calcilytics directly targeting the CASR are in the pipeline. Specific clinical guidance for treatment and monitoring of ADH1 patients is lacking. The purpose of this study is to provide a literature review on management of ADH1, including new therapies, and to formulate practice recommendations.MethodsWe searched for articles and ongoing clinical trials regarding management of ADH1.ResultsForty articles were included. First we review the conventional treatment of ADH1, focusing on active vitamin D, calcium supplements, thiazide diuretics, phosphorus binders and dietary recommendations. In a second part we give an overview of studies with emerging treatments in ADH1: PTH analogues (PTH1-34, rhPTH1-84, TransCon PTH and others) and calcilytics (preclinical studies and clinical trials). In a third part we discuss literature findings regarding monitoring of ADH1 patients. Finally, we formulate clinical practice recommendations.ConclusionWe provide an overview of conventional and new treatments for ADH1 patients. Based on these data, we propose practical recommendations to assist clinicians in the management of ADH1 patients.

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Calcium is a vital trace element for the human body, and its deficiency can result in a range of pathological conditions, including rickets and osteoporosis. Despite the numerous types of calcium supplements currently available on the market, these products are afflicted with a number of inherent deficiencies, such as low calcium content, poor aqueous solubility, and low human absorption rate. Many microorganisms, particularly beneficial microorganisms, including edible fungi, lactic acid bacteria, and yeast, are capable of absorbing and enriching calcium, a phenomenon that has been widely documented. This opens the door to the potential utilization of microorganisms as novel calcium enrichment carriers. However, the investigation of calcium-rich foods from microorganisms still faces many obstacles, including a poor understanding of calcium metabolic pathways in microorganisms, a relatively low calcium enrichment rate, and the slow growth of strains. Therefore, in order to promote the development of calcium-rich products from microorganisms, this paper provides an overview of the impacts of calcium addition on strain growth, calcium enrichment rate, antioxidant system, and secondary metabolite production. Additionally, it highlights calcium transport and enrichment mechanisms in microorganism cells and offers a detailed account of the progress made on calcium-binding proteins, calcium transport pathways, and calcium storage and release. This paper offers insights for further research on the relevant calcium enrichment in microorganism cells.

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