葡萄糖酸钙

葡萄糖酸钙
临床资料
读音	KAL-see-um GLUE-koe-nate
AHFS/Drugs.com	Monograph
核准状况	美 DailyMed: gluconate Calcium gluconate;
给药途径	口服给药、静脉注射与外用药物
ATC码	A12AA03 (WHO) (口服用), D11AX03, B05XA19 (注射用);
识别信息
	IUPAC命名法 calcium (2R,3S,4R,5R)- 2,3,4,5,6-pentahydroxyhexanoate; ;
CAS号	299-28-5
PubChem CID	9290;
DrugBank	DB11126;
ChemSpider	8932;
UNII	SQE6VB453K;
KEGG	D00935;
ChEBI	CHEBI:3309;
ChEMBL	ChEMBL2106119;
E编码	E578 (acidity regulators, ...)
CompTox Dashboard（英语：CompTox Chemicals Dashboard） (EPA)	DTXSID2029618 ;
ECHA InfoCard	100.005.524
化学信息
化学式	C12H22CaO14
摩尔质量	430.37 g·mol−1
3D模型（JSmol（英语：JSmol））	交互式图像;
熔点	120 °C（248 °F） (分解)
水溶性	缓慢水溶性
	SMILES [Ca+2].[O-]C(=O)[C@H](O)[C@@H](O)[C@H](O)[C@H](O)CO.[O-]C(=O)[C@H](O)[C@@H](O)[C@H](O)[C@H](O)CO;
	InChI InChI=1S/2C6H12O7.Ca/c27-1-2(8)3(9)4(10)5(11)6(12)13;/h22-5,7-11H,1H2,(H,12,13);/q;;+2/p-2/t2*2-,3-,4+,5-;/m11./s1; Key:NEEHYRZPVYRGPP-IYEMJOQQSA-L;

葡萄糖酸钙（英语：Calcium gluconate）是钙盐形式的葡萄糖酸，可用作矿物质补充剂及药物。^[1]作药物用时是透过静脉注射方式来治疗低血钙症、高钾血症和高镁血症（英语：Hypermagnesemia）。^[1]^[2]一般是饮食中钙含量不足时才需补充。^[3]补充钙可用在治疗或是预防骨质疏松症或佝偻病。^[1]通常的摄取方式是透过口服及静脉注射，不建议采肌肉注射方式。^[1]

Quick Facts 临床资料, 读音 ...

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注射使用的副作用有心跳过缓、注射部位疼痛和血压降低。^[3]口服使用的副作用有便秘和恶心。^[1]摄取时应先测量血钙水平，有肾结石病史的个体应格外小心。^[3]在正常剂量的情况，个体于怀孕期间对于胎儿，以及进行母乳哺育时对于婴儿被认为属于安全。^[1]^[4]葡萄糖酸钙是将葡萄糖酸与碳酸钙或是氢氧化钙混合制成。^[5]

葡萄糖酸钙从20世纪20年代开始即被用于医疗用途。^[6]它已被列入世界卫生组织基本药物标准清单之中。^[7]目前葡萄糖酸钙均以通用名药物形式在市面上贩售。^[2]^[8]

生产

商业化生产葡萄糖酸钙的方法主要有三种：用次氯酸盐（英语：hypochlorite）溶液将葡萄糖进行氧化、对含有溴化物的葡萄糖溶液进行电解氧化，以及在含有葡萄糖和其他成分的培养基中利用特定微生物进行发酵。^[9]

医疗用途

低血钙症

治疗低血钙症使用最广的方式是将10%葡萄糖酸钙溶液以静脉注射方式输入人体。但此形式的钙在吸收效果上会次于乳酸钙（英语：Calcium lactate），^[10]且这种溶液仅含有0.93% (930克/分升) 钙离子（定义为100升溶液中含有1克重量溶质，制成含1%重量/体积的溶液）。当低血钙症是急性且严重时，该改而使用氯化钙。

高钾血症

葡萄糖酸钙被用来保护有高水平钾血个体的心脏之用，另一选择是使用氯化钙。^[11]当血液中钾水平较高（>6.5毫摩尔/升）或心电图（ECG）因高钾血而显示异常时，建议使用葡萄糖酸钙。^[2]

虽然摄取葡萄糖酸钙对血液中的钾含量不发生影响，但可降低心肌的兴奋性，而将心律不整的可能性降低。^[12]

硫酸镁过量

葡萄糖酸钙也用于抵消过量摄取泻盐（硫酸镁）的作用，^[13]硫酸镁通常用于孕妇以预防癫痫发作（如患有子痫前症的个体）。过量摄取硫酸镁会产生硫酸镁毒性，导致呼吸抑制和深部肌腱反射能力降低（腱反射减弱（英语：hyporeflexia））。

氢氟酸灼伤

含葡萄糖酸钙的凝胶制剂可用于处理氢氟酸灼伤。^[14]^[15]葡萄糖酸钙与氢氟酸反应后可生成不溶性且无毒的氟化钙。患者除可直接将含2.5%葡萄糖酸钙凝胶涂敷在灼伤处外，还可接受葡萄糖酸钙补充剂，因为氟离子会沉淀血清钙，导致低血钙症。^[16]

心搏停止

虽然静脉注射钙可用于处理心搏停止，但一般并不建议直接使用（可能会导致结果恶化）。^[1]而建议将其使用于会导致心搏停止的状况，如高钾血症、低血钙症（可能于输血后发生）以及钙离子通道阻滞剂中毒。^[1]碰到前述情况，通常建议使用的是氯化钙。^[1]

副作用

使用葡萄糖酸钙的副作用有恶心、便秘和胃部不适。在快速静脉注射后可能会引起高血钙症，导致血管舒张、心律不整、血压下降和心跳过缓。葡萄糖酸钙发生静脉注射外渗（英语：Extravasation (intravenous)）时，有导致蜂窝性组织炎的可能。肌肉注射可能导致局部组织坏死和脓疡形成。^[17]

另据报导，使用葡萄糖酸钙会增加个体的肾血流量、排尿增量、发生利钠（英语：Natriuresis）（强化钠排泄）、^[18]^[19]提升肾小球滤过率^[20]以及升高前列腺素E2和F1-α水平。^[21]

社会与文化

美国于2012年11月和2015年11月报告有医用葡萄糖酸钙短暂性短缺的情况，推测原因可能是生产方面问题、供应链问题和需求增加所导致。^[11]^[22]
以往曾将静脉注射葡萄糖酸钙用作黑寡妇蜘蛛叮咬后的解毒剂，常会结合肌肉松弛剂使用。^[23]然而这种疗法后来被证明并无效果。^[24]^[25]

参见

葡萄糖酸乳酸钙（英语：Calcium lactate gluconate）
柠檬酸钙
磷酸氢钙

参考文献

[1]
Calcium Salts. The American Society of Health-System Pharmacists. [2017-01-08]. （原始内容存档于2017-01-18）.
[2]
British national formulary : BNF 69 69. British Medical Association. 2015: 680, 694. ISBN 9780857111562.
[3]
World Health Organization. Stuart MC, Kouimtzi M, Hill SR , 编. WHO Model Formulary 2008. World Health Organization. 2009: 497. ISBN 9789241547659. hdl:10665/44053.
[4]
Calcium gluconate Use During Pregnancy | Drugs.com. www.drugs.com. [2017-01-15]. （原始内容存档于2017-01-18）.
[5]
Bhattacharya S. Conventional and Advanced Food Processing Technologies. John Wiley & Sons. 2014: 391. ISBN 9781118406304. （原始内容存档于2017-09-18）（英语）.
[6]
Tegethoff FW. Calcium Carbonate: From the Cretaceous Period into the 21st Century. Birkhäuser. 2012: 308. ISBN 9783034882453. （原始内容存档于2017-09-18）（英语）.
[7]
World Health Organization. World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. hdl:10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
[8]
Competitive Generic Therapy Approvals. U.S. Food and Drug Administration (FDA). 2023-06-29 [2023-06-29]. （原始内容存档于2023-06-29）.
[9]
Shindia AA, El-Sherbeny GA, El-Esawy AE, Sheriff YM. Production of gluconic Acid by some local fungi. Mycobiology. March 2006, 34 (1): 22–29. PMC 3769535 . PMID 24039465. doi:10.4489/MYCO.2006.34.1.022.
[10]
Spencer H, Scheck J, Lewin I, Samachson J. Comparative absorption of calcium from calcium gluconate and calcium lactate in man. The Journal of Nutrition. July 1966, 89 (3): 283–292. PMID 4288031. doi:10.1093/jn/89.3.283.
[11]
Miller D, Faine B. The Calcium Quandary. Emergency Physicians Monthly. December 2013 [2015-11-20]. （原始内容存档于2015-11-21）.
[12]
Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Texas Heart Institute Journal. 2006, 33 (1): 40–47. PMC 1413606 . PMID 16572868.
[13]
Omu AE, Al-Harmi J, Vedi HL, Mlechkova L, Sayed AF, Al-Ragum NS. Magnesium sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait. Medical Principles and Practice. 2008, 17 (3): 227–232. PMID 18408392. S2CID 3079436. doi:10.1159/000117797.
[14]
el Saadi MS, Hall AH, Hall PK, Riggs BS, Augenstein WL, Rumack BH. Hydrofluoric acid dermal exposure. Veterinary and Human Toxicology. June 1989, 31 (3): 243–247. PMID 2741315.
[15]
Roblin I, Urban M, Flicoteau D, Martin C, Pradeau D. Topical treatment of experimental hydrofluoric acid skin burns by 2.5% calcium gluconate. Journal of Burn Care & Research. 2006, 27 (6): 889–894. PMID 17091088. S2CID 3691306. doi:10.1097/01.BCR.0000245767.54278.09.
[16]
Urden LD. Critical Care Nursing : Diagnosis and Management 7th. St. Louis, Mo.: Elsevier/Mosby. 2014: 936. ISBN 978-0-323-09178-7. OCLC 830669119.
[17]
Lam YM, Tse HF, Lau CP. Continuous calcium chloride infusion for massive nifedipine overdose. Chest. April 2001, 119 (4): 1280–1282. PMID 11296202. doi:10.1378/chest.119.4.1280.
[18]
Ruilope LM, Oliet A, Alcázar JM, Hernández E, Andrés A, Rodicio JL, et al. Characterization of the renal effects of an intravenous calcium gluconate infusion in normotensive volunteers. Journal of Hypertension Supplement. December 1989, 7 (6): S170–S171. PMID 2632708. doi:10.1097/00004872-198900076-00081.
[19]
Bernardi M, Di Marco C, Trevisani F, Fornalè L, Andreone P, Cursaro C, et al. Renal sodium retention during upright posture in preascitic cirrhosis. Gastroenterology. July 1993, 105 (1): 188–193. PMID 8514034. doi:10.1016/0016-5085(93)90025-8.
[20]
Wong F, Massie D, Colman J, Dudley F. Glomerular hyperfiltration in patients with well-compensated alcoholic cirrhosis. Gastroenterology. March 1993, 104 (3): 884–889. PMID 8440439. doi:10.1016/0016-5085(93)91026-e.
[21]
Lahera V, Fiksen-Olsen MJ, Romero JC. Stimulation of renin release by intrarenal calcium infusion. Hypertension. February 1990, 15 (2 Suppl): I149–I152. PMID 2404858. doi:10.1161/01.hyp.15.2_suppl.i149 .
[22]
FDA Drug Shortages. www.accessdata.fda.gov. [2015-11-21]. （原始内容存档于2017-09-18）.
[23]
Pestana C. Dr. Pestana's Surgery Notes: Top 180 Vignettes for the Surgical Wards.. Simon and Schuster. July 2015. ISBN 978-1-5062-0201-3.
[24]
Offerman SR, Daubert GP, Clark RF. The treatment of black widow spider envenomation with antivenin latrodectus mactans: a case series. The Permanente Journal. 2011, 15 (3): 76–81. PMC 3200105 . PMID 22058673. doi:10.7812/tpp/10-136.
[25]
Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Annals of Emergency Medicine. July 1992, 21 (7): 782–787. PMID 1351707. doi:10.1016/S0196-0644(05)81021-2.

外部链接

Calcium gluconate. Drug Information Portal. U.S. National Library of Medicine. [2024-03-25]. （原始内容存档于2019-12-17）.

[AHFS2017-1] [1]
Calcium Salts. The American Society of Health-System Pharmacists. [2017-01-08]. （原始内容存档于2017-01-18）.

[BNF69-2] [2]
British national formulary : BNF 69 69. British Medical Association. 2015: 680, 694. ISBN 9780857111562.

[WHO2008-3] [3]
World Health Organization. Stuart MC, Kouimtzi M, Hill SR , 编. WHO Model Formulary 2008. World Health Organization. 2009: 497. ISBN 9789241547659. hdl:10665/44053.

[4] [4]
Calcium gluconate Use During Pregnancy | Drugs.com. www.drugs.com. [2017-01-15]. （原始内容存档于2017-01-18）.

[5] [5]
Bhattacharya S. Conventional and Advanced Food Processing Technologies. John Wiley & Sons. 2014: 391. ISBN 9781118406304. （原始内容存档于2017-09-18）（英语）.

[6] [6]
Tegethoff FW. Calcium Carbonate: From the Cretaceous Period into the 21st Century. Birkhäuser. 2012: 308. ISBN 9783034882453. （原始内容存档于2017-09-18）（英语）.

[WHO21st-7] [7]
World Health Organization. World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. hdl:10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.

[8] [8]
Competitive Generic Therapy Approvals. U.S. Food and Drug Administration (FDA). 2023-06-29 [2023-06-29]. （原始内容存档于2023-06-29）.

[9] [9]
Shindia AA, El-Sherbeny GA, El-Esawy AE, Sheriff YM. Production of gluconic Acid by some local fungi. Mycobiology. March 2006, 34 (1): 22–29. PMC 3769535 . PMID 24039465. doi:10.4489/MYCO.2006.34.1.022.

[10] [10]
Spencer H, Scheck J, Lewin I, Samachson J. Comparative absorption of calcium from calcium gluconate and calcium lactate in man. The Journal of Nutrition. July 1966, 89 (3): 283–292. PMID 4288031. doi:10.1093/jn/89.3.283.

[:0-11] [11]
Miller D, Faine B. The Calcium Quandary. Emergency Physicians Monthly. December 2013 [2015-11-20]. （原始内容存档于2015-11-21）.

[12] [12]
Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Texas Heart Institute Journal. 2006, 33 (1): 40–47. PMC 1413606 . PMID 16572868.

[pmid18408392-13] [13]
Omu AE, Al-Harmi J, Vedi HL, Mlechkova L, Sayed AF, Al-Ragum NS. Magnesium sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait. Medical Principles and Practice. 2008, 17 (3): 227–232. PMID 18408392. S2CID 3079436. doi:10.1159/000117797.

[pmid2741315-14] [14]
el Saadi MS, Hall AH, Hall PK, Riggs BS, Augenstein WL, Rumack BH. Hydrofluoric acid dermal exposure. Veterinary and Human Toxicology. June 1989, 31 (3): 243–247. PMID 2741315.

[pmid17091088-15] [15]
Roblin I, Urban M, Flicoteau D, Martin C, Pradeau D. Topical treatment of experimental hydrofluoric acid skin burns by 2.5% calcium gluconate. Journal of Burn Care & Research. 2006, 27 (6): 889–894. PMID 17091088. S2CID 3691306. doi:10.1097/01.BCR.0000245767.54278.09.

[16] [16]
Urden LD. Critical Care Nursing : Diagnosis and Management 7th. St. Louis, Mo.: Elsevier/Mosby. 2014: 936. ISBN 978-0-323-09178-7. OCLC 830669119.

[17] [17]
Lam YM, Tse HF, Lau CP. Continuous calcium chloride infusion for massive nifedipine overdose. Chest. April 2001, 119 (4): 1280–1282. PMID 11296202. doi:10.1378/chest.119.4.1280.

[pmid2632708-18] [18]
Ruilope LM, Oliet A, Alcázar JM, Hernández E, Andrés A, Rodicio JL, et al. Characterization of the renal effects of an intravenous calcium gluconate infusion in normotensive volunteers. Journal of Hypertension Supplement. December 1989, 7 (6): S170–S171. PMID 2632708. doi:10.1097/00004872-198900076-00081.

[pmid8514034-19] [19]
Bernardi M, Di Marco C, Trevisani F, Fornalè L, Andreone P, Cursaro C, et al. Renal sodium retention during upright posture in preascitic cirrhosis. Gastroenterology. July 1993, 105 (1): 188–193. PMID 8514034. doi:10.1016/0016-5085(93)90025-8.

[pmid8440439-20] [20]
Wong F, Massie D, Colman J, Dudley F. Glomerular hyperfiltration in patients with well-compensated alcoholic cirrhosis. Gastroenterology. March 1993, 104 (3): 884–889. PMID 8440439. doi:10.1016/0016-5085(93)91026-e.

[pmid2404858-21] [21]
Lahera V, Fiksen-Olsen MJ, Romero JC. Stimulation of renin release by intrarenal calcium infusion. Hypertension. February 1990, 15 (2 Suppl): I149–I152. PMID 2404858. doi:10.1161/01.hyp.15.2_suppl.i149 .

[22] [22]
FDA Drug Shortages. www.accessdata.fda.gov. [2015-11-21]. （原始内容存档于2017-09-18）.

[23] [23]
Pestana C. Dr. Pestana's Surgery Notes: Top 180 Vignettes for the Surgical Wards.. Simon and Schuster. July 2015. ISBN 978-1-5062-0201-3.

[24] [24]
Offerman SR, Daubert GP, Clark RF. The treatment of black widow spider envenomation with antivenin latrodectus mactans: a case series. The Permanente Journal. 2011, 15 (3): 76–81. PMC 3200105 . PMID 22058673. doi:10.7812/tpp/10-136.

[25] [25]
Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Annals of Emergency Medicine. July 1992, 21 (7): 782–787. PMID 1351707. doi:10.1016/S0196-0644(05)81021-2.

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