Ca in dig toxicity

Q: Calcium can be administrated to hyperkalemic patients in digitalis (Dig) toxicity? 

A) Yes

B) No

Answer: A

Although common teaching at the bedside is to avoid calcium in hyperkalemia associated with dig. toxicity, the hyperkalemia should be treated with calcium for cardiac membrane stabilization in the same way as in any other patient or for similar EKG changes, i.e., loss of P waves and/or widening of the QRS complex. This is true even though hypercalcemia may potentiate the cardiotoxic effects of dig. Again, calcium is required to counter the membrane actions of hyperkalemia. 

Said that calcium should be given slowly in hyperkalemia associated with dig. toxicity. It can be given as 10-10-100 rule means 10 mL of 10 percent calcium gluconate in 100 mL of 5 percent dextrose in water (d-5 W) over 30 minutes. The formula can be extended as 10-10-100-5-30.

#electrolytes

#cardiology

#toxicity

References:

1. Mount DB. Disorders of potassium balance. In: Brenner and Rector's The Kidney, 11th ed, Yu A, Chertow G, Luyckx V, et al (Eds), W.B. Saunders & Company, Philadelphia 2020. p.537.

2. Levine M, Nikkanen H, Pallin DJ. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg Med. 2011 Jan;40(1):41-6. doi: 10.1016/j.jemermed.2008.09.027. Epub 2009 Feb 6. PMID: 19201134.