Date: Fri, 11 Jun 2010 16:45:21 -0500
Reply-To: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
Sender: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
From: "Tsiakals, Nicholas John" <tsiakals**At_Symbol_Here**ILLINOIS.EDU>
Subject: Re: toxicity question
In-Reply-To: <SNT116-W2683DF409A2F9F616E6498C4D90**At_Symbol_Here**phx.gbl>

Sounds like you’re saying that comparing the solubilit y of one salt to another plays a part in that overall dosing question.

That helps, Alan.  Thanks!


From: DCHAS-L Discu ssion List [mailto:DCHAS-L**At_Symbol_Here**LIST.UVM.EDU] On Behalf Of Alan Hall
Sent: Friday, June 11, 2010 9:41 AM
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU
Subject: Re: [DCHAS-L] toxicity question

Nick et al,
In general, the toxicity would not change with the salt involved, alth ough there are exceptions.  For example, when treating hydrofluoric acid (H F) exposures with calcium salts, the calcium gluconate salt can be used topica lly, injected intradermally, or given intravenously or interarterially.  However, the calcium chloride salt can only be injected intravenously, beca use it causes severe skin damage and sloughing if extravasated from a vein or injected intradermally and can cause devastating vascular injury if injecte d intraarterially.  
Calcium salts are also a good example of the second point.  The dose o f the active ingredient can vary significantly with the same volume of differ ent salts.  In the calcium example, the calcium chloride salt in a gi ven volume will have approximately 3 times more Ca+2 ion that the same volume o f the calcium gluconate salt.  When treating life-threatening cardiovasc ular complications of hydrofluoric acid systemic toxicity, it is therefore often wise to choose the calcium chloride salt for intravenous infusion (with precautions against extravaasation), as a much higher dose of calcium ion c an provided with the same volume and the same infusion time.
A similar comparison might be made for norepinephrine, but what the relationship of dose is between various salt forms in the same volume, I do n't have memorized.
Hope this answers the question.
Alan H. Hall, M.D.
President and Chief Medical Toxicologist
Toxicology Consulting and Medical Translating Services, Inc.
Laramie, WY
Clinical Assistant Professor
Colorado School of Public Health
Denver, CO
> Date: Thu, 10 Jun 2010 16:30:45 -0500
> From: tsiakals**At_Symbol_Here**ILLINOIS.EDU
> Subject: [DCHAS-L] toxicity question
> To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU
> Good afternoon all,
> How does toxicity compare from one pharmaceutical salt to another? Mor e specifically, is the toxicity of norepinephrine the same as norepinephrine bitartrate salt?
> Thanks,
> -Nick

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