葡萄糖酸鈣

葡萄糖酸鈣
臨床資料
讀音	KAL-see-um GLUE-koe-nate
AHFS/Drugs.com	Monograph
核准狀況	美 DailyMed: gluconate Calcium gluconate;
給藥途徑	口服給藥、靜脈注射與外用藥物
ATC碼	A12AA03 (WHO) (口服用), D11AX03, B05XA19 (注射用);
識別資訊
	IUPAC命名法 calcium (2R,3S,4R,5R)- 2,3,4,5,6-pentahydroxyhexanoate; ;
CAS號	299-28-5
PubChem CID	9290;
DrugBank	DB11126;
ChemSpider	8932;
UNII	SQE6VB453K;
KEGG	D00935;
ChEBI	CHEBI:3309;
ChEMBL	ChEMBL2106119;
E編碼	E578 (acidity regulators, ...)
CompTox Dashboard（英語：CompTox Chemicals Dashboard） (EPA)	DTXSID2029618 ;
ECHA InfoCard	100.005.524
化學資訊
化學式	C12H22CaO14
摩爾質量	430.37 g·mol−1
3D模型（JSmol（英語：JSmol））	交互式圖像;
熔點	120 °C（248 °F） (分解)
水溶性	緩慢水溶性
	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;

葡萄糖酸鈣（英語：Calcium gluconate）是鈣鹽形式的葡萄糖酸，可用作礦物質補充劑及藥物。^[1]作藥物用時是透過靜脈注射方式來治療低血鈣症、高鉀血症和高鎂血症（英語：Hypermagnesemia）。^[1]^[2]一般是飲食中鈣含量不足時才需補充。^[3]補充鈣可用在治療或是預防骨質疏鬆症或佝僂病。^[1]通常的攝取方式是透過口服及靜脈注射，不建議採肌肉注射方式。^[1]

Quick Facts 臨床資料, 讀音 ...

Close

注射使用的副作用有心跳過緩、注射部位疼痛和血壓降低。^[3]口服使用的副作用有便秘和噁心。^[1]攝取時應先測量血鈣水平，有腎結石病史的個體應格外小心。^[3]在正常劑量的情況，個體於懷孕期間對於胎兒，以及進行母乳哺育時對於嬰兒被認為屬於安全。^[1]^[4]葡萄糖酸鈣是將葡萄糖酸與碳酸鈣或是氫氧化鈣混合製成。^[5]

葡萄糖酸鈣從20世紀20年代開始即被用於醫療用途。^[6]它已被列入世界衛生組織基本藥物標準清單之中。^[7]目前葡萄糖酸鈣均以通用名藥物形式在市面上販售。^[2]^[8]

生產

商業化生產葡萄糖酸鈣的方法主要有三種：用次氯酸鹽（英語：hypochlorite）溶液將葡萄糖進行氧化、對含有溴化物的葡萄糖溶液進行電解氧化，以及在含有葡萄糖和其他成分的培養基中利用特定微生物進行發酵。^[9]

醫療用途

低血鈣症

治療低血鈣症使用最廣的方式是將10%葡萄糖酸鈣溶液以靜脈注射方式輸入人體。但此形式的鈣在吸收效果上會次於乳酸鈣（英語：Calcium lactate），^[10]且這種溶液僅含有0.93% (930克/分升) 鈣離子（定義為100升溶液中含有1克重量溶質，製成含1%重量/體積的溶液）。當低血鈣症是急性且嚴重時，該改而使用氯化鈣。

高鉀血症

葡萄糖酸鈣被用來保護有高水平鉀血個體的心臟之用，另一選擇是使用氯化鈣。^[11]當血液中鉀水平較高（>6.5毫摩爾/升）或心電圖（ECG）因高鉀血而顯示異常時，建議使用葡萄糖酸鈣。^[2]

雖然攝取葡萄糖酸鈣對血液中的鉀含量不發生影響，但可降低心肌的興奮性，而將心律不整的可能性降低。^[12]

硫酸鎂過量

葡萄糖酸鈣也用於抵消過量攝取瀉鹽（硫酸鎂）的作用，^[13]硫酸鎂通常用於孕婦以預防癲癇發作（如患有子癇前症的個體）。過量攝取硫酸鎂會產生硫酸鎂毒性，導致呼吸抑制和深部肌腱反射能力降低（腱反射減弱（英語：hyporeflexia））。

氫氟酸灼傷

含葡萄糖酸鈣的凝膠製劑可用於處理氫氟酸灼傷。^[14]^[15]葡萄糖酸鈣與氫氟酸反應後可生成不溶性且無毒的氟化鈣。患者除可直接將含2.5%葡萄糖酸鈣凝膠塗敷在灼傷處外，還可接受葡萄糖酸鈣補充劑，因為氟離子會沉澱血清鈣，導致低血鈣症。^[16]

心搏停止

雖然靜脈注射鈣可用於處理心搏停止，但一般並不建議直接使用（可能會導致結果惡化）。^[1]而建議將其使用於會導致心搏停止的狀況，如高鉀血症、低血鈣症（可能於輸血後發生）以及鈣離子通道阻滯劑中毒。^[1]碰到前述情況，通常建議使用的是氯化鈣。^[1]

副作用

使用葡萄糖酸鈣的副作用有噁心、便秘和胃部不適。在快速靜脈注射後可能會引起高血鈣症，導致血管舒張、心律不整、血壓下降和心跳過緩。葡萄糖酸鈣發生靜脈注射外滲（英語：Extravasation (intravenous)）時，有導致蜂窩性組織炎的可能。肌肉注射可能導致局部組織壞死和膿瘍形成。^[17]

另據報導，使用葡萄糖酸鈣會增加個體的腎血流量、排尿增量、發生利鈉（英語：Natriuresis）（強化鈉排泄）、^[18]^[19]提升腎小球濾過率（英語：Glomerular filtration rate）^[20]以及升高前列腺素E2和F1-α水平。^[21]

社會與文化

美國於2012年11月和2015年11月報告有醫用葡萄糖酸鈣短暫性短缺的情況，推測原因可能是生產方面問題、供應鏈問題和需求增加所導致。^[11]^[22]
以往曾將靜脈注射葡萄糖酸鈣用作黑寡婦蜘蛛叮咬後的解毒劑，常會結合肌肉鬆弛劑使用。^[23]然而這種療法後來被證明並無效果。^[24]^[25]

參見

葡萄糖酸乳酸鈣（英語：Calcium lactate gluconate）
檸檬酸鈣
磷酸氫鈣

參考文獻

[1]
Calcium Salts. The American Society of Health-System Pharmacists. [2017-01-08]. （原始內容存檔於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 , 編. 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]. （原始內容存檔於2017-01-18）.
[5]
Bhattacharya S. Conventional and Advanced Food Processing Technologies. John Wiley & Sons. 2014: 391. ISBN 9781118406304. （原始內容存檔於2017-09-18）（英語）.
[6]
Tegethoff FW. Calcium Carbonate: From the Cretaceous Period into the 21st Century. Birkhäuser. 2012: 308. ISBN 9783034882453. （原始內容存檔於2017-09-18）（英語）.
[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]. （原始內容存檔於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]. （原始內容存檔於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]. （原始內容存檔於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.

外部連結

Calcium gluconate. Drug Information Portal. U.S. National Library of Medicine. [2024-03-25]. （原始內容存檔於2019-12-17）.

[AHFS2017-1] [1]
Calcium Salts. The American Society of Health-System Pharmacists. [2017-01-08]. （原始內容存檔於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 , 編. 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]. （原始內容存檔於2017-01-18）.

[5] [5]
Bhattacharya S. Conventional and Advanced Food Processing Technologies. John Wiley & Sons. 2014: 391. ISBN 9781118406304. （原始內容存檔於2017-09-18）（英語）.

[6] [6]
Tegethoff FW. Calcium Carbonate: From the Cretaceous Period into the 21st Century. Birkhäuser. 2012: 308. ISBN 9783034882453. （原始內容存檔於2017-09-18）（英語）.

[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]. （原始內容存檔於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]. （原始內容存檔於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]. （原始內容存檔於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.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]