A liquid calcium+vitamin D3 supplement is effective prophylaxis against hypocalcemic toxicity during apheresis platelet donation

Basic principles of therapeutic plasma exchange

Therapeutic plasma exchange is a method of treatment for clinical conditions that represent diverse fields of medicine. The rationale for this mode of therapy is based on sound mathematical modeling of the synthesis and removal of large molecules, usually proteins, from the circulation. The basic assumptions underlying therapeutic plasma exchange are that a clinical illness is caused by, or related to, a pathogenic substance in the plasma, and that removing that substance from the plasma will alleviate the patient's illness. This approach has proven applicable to a wide variety of clinical conditions. Therapeutic plasma exchange is largely a safe procedure in experienced hands. The principal adverse effect, the hypocalcemic reaction, is readily ameliorated or prevented.

Bone Turnover Markers Changes Induced by Plateletpheresis May Be Minimized with Oral Supplementation of Calcium, Minerals, and Vitamin D before the Procedures: A Non-Randomized, Controlled Study

Apheresis allows the collection of specific blood components but changes serum calcium (Ca), magnesium (Mg), copper (Cu), zinc (Zn), and hormones involved in bone metabolism due to citrate infusion. We assessed the effect of oral supplementation of calcium, vitamin D, and minerals as pills or an enriched diet before plateletpheresis donation on levels of divalent cations, hormones, and bone turnover markers that may prevent metabolic changes. Methods: Non-randomized controlled study including 134 donors. Serum parathyroid hormone (PTH), Ca, Mg, Zn, Cu, osteocalcin (OC), vitamin D, and type-1 collagen C-terminal telopeptide (CTX-1) levels were measured at baseline and post-procedure. Donors were divided into four groups: supplemented with calcium carbonate and vitamin D (cal + vitd); those receiving calcium, minerals, and vitamin D (cal + vitd + min); those receiving a calcium-rich diet (diet) and a control group (control). Results: PTH levels increased >1-fold, whereas tCa, tMg, Zn, Cu, iCa, iMg, and vitamin D levels decreased immediately after apheresis amongst donors of any group; when these levels were measured two weeks later, donors in the calcium-vitd and cal + vitd + min groups returned to basal values; donors in the cal + vitd + min group were the only group that kept their levels of OC and CTX unchanged at the different study times. Conclusions: Bone turnover markers changes induced by plateletpheresis may be minimized with oral supplementation of calcium, minerals, and vitamin D two days before the procedures.

The Efficacy of Calcium Carbonate-Vitamin D3 in Pregnant Women for the Prevention of Hypertensive Disorders in Pregnancy

Objective

To evaluate the efficacy of calcium carbonate-vitamin D3 in pregnant women for the prevention of hypertensive disorders in pregnancy.

Methods

Between April 2020 and June 2021, 60 pregnant women undergoing prenatal examinations in our hospital were recruited and assigned via the random number table method at a ratio of 1 : 1 to receive conventional pregnancy care (observation group) or conventional pregnancy care plus calcium carbonate-vitamin D3 administration (experimental group). Outcome measures included blood pressure, blood calcium, the occurrence of hypertensive disorders, and adverse events.

Results

The diastolic blood pressure (DBP) and systolic blood pressure (SBP) levels at delivery in the experimental group were significantly lower than those in the observation group (P < 0.05). Pregnant women in the experimental group had significantly higher blood calcium levels at labor than those in the observation group (P < 0.05). The administration of calcium carbonate-vitamin D3 resulted in a significantly lower incidence of hypertensive disorders and adverse events versus conventional pregnancy care (P < 0.05).

Conclusion

The effect of calcium carbonate-vitamin D3 administration during pregnancy for the prevention of hypertensive disorders is significant, which effectively improves the blood calcium level of pregnant women and reduces the occurrence of adverse events, so it is worthy of clinical promotion and application.

Edible CaCO3 nanoparticles stabilized Pickering emulsion as calcium-fortified formulation

Background

Nanoparticles assembled from food-grade calcium carbonate have attracted attention because of their biocompatibility, digestibility, particle and surface features (such as size, surface area, and partial wettability), and stimuli-responsiveness offered by their acid-labile nature.

Results

Herein, a type of edible oil-in-water Pickering emulsion was structured by calcium carbonate nanoparticles (CaCO₃ NPs; mean particle size: 80 nm) and medium-chain triglyceride (MCT) for delivery of lipophilic drugs and simultaneous oral supplementation of calcium. The microstructure of the as-made CaCO₃ NPs stabilized Pickering emulsion can be controlled by varying the particle concentration (c) and oil volume fraction (φ). The emulsification stabilizing capability of the CaCO₃ NPs also favored the formation of high internal phase emulsion at a high φ of 0.7–0.8 with excellent emulsion stability at room temperature and at 4 °C, thus protecting the encapsulated lipophilic bioactive, vitamin D3 (VD3), against degradation. Interestingly, the structured CaCO₃ NP-based Pickering emulsion displayed acid-trigged demulsification because of the disintegration of the CaCO₃ NPs into Ca²⁺ in a simulated gastric environment, followed by efficient lipolysis of the lipid in simulated intestinal fluid. With the encapsulation and delivery of the emulsion, VD3 exhibited satisfying bioavailability after simulated gastrointestinal digestion.

Conclusions

Taken together, the rationally designed CaCO₃ NP emulsion system holds potential as a calcium-fortified formulation for food, pharmaceutical and biomedical applications.

Solving the calcium gluconate shortage in real-time: Mistakes made and lessons learned

PURPOSE

During a national shortage of calcium gluconate, we switched to calcium chloride for routine supplementation for peripheral blood stem cell (PBSC) collections. Subsequently, we analyzed the postprocedure ionized calcium level, as we aimed for an equivalent result compared to before the shortage.

METHODS

Pharmacy representatives helped us to find an "equivalent" substitute for calcium gluconate at 46.5 mEq in 500 mL normal saline, infused at 100 mL/hour. After instituting a presumably comparable protocol using calcium chloride (40.8 mEq in 250 mL normal saline at a rate of 100 mL/hour), we reviewed ionized calcium results post-PBSC procedures to compare with those obtained with calcium gluconate. Having noticed a difference in the mean values, we adjusted the rate of calcium chloride to reach our desired outcome.

RESULTS

Twenty-seven procedures were analyzed on 15 unique patients. We used the Spectra OPTIA with a whole blood: anticoagulant ratio of 13:1. Ionized calcium levels post-PBSC collection with the first calcium chloride protocol were significantly higher (P = 0.003) in nine patients treated. Subsequently, we decreased the calcium chloride infusion rate to 75 mL/hour and achieved similar mean levels to calcium gluconate (P = 0.382).

CONCLUSION

Changes in replacement fluids for apheresis procedures can be complex, particularly when dealing with electrolytes that could be clinically significant at critically high or low levels. Once we recognized the need to take into account the amount of elemental calcium infused, we achieved the desired postprocedure ionized calcium results. This study can serve as a lesson for future shortages of infusions used during apheresis procedures.