Date: Fri, 11 Jun 2010 16:34:00 -0600
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: Alan Hall <ahalltoxic**At_Symbol_Here**MSN.COM>
Subject: Re: toxicity question
In-Reply-To: <F5D83326DC77FD4EA138E9194D6B28883371E83CA2**At_Symbol_Here**>

Just to elucidate the issue, erythromycin ethly succinate (EES)&nb sp;in certain forms could cause non-obstructive colestaitc jaundice in ce rtain clinical scenarios, while all other forms of erythromycin did not d o so.  Outdated tetracycline in some salt forms could injure the kid neys, while non-outdated forms of the same antibiotic did not.
I regret that from the toxicological standpoint, your question cannot be simply answered.  In a long life as a medical toxicologist, I find that there really are not often any simple answers.  The more we le arn, sometimes the less certain we become. 


Date: Fri, 11 Jun 2010 16:45:21 -0500
From: tsiakals**At_Symbol_Here**ILLINOIS.EDU
S ubject: Re: [DCHAS-L] toxicity question
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU

Sounds like you=92re saying that co mparing the solubility of one salt to another plays a part in that overall dosing question.


That helps, Alan.  Thanks!




From: DCHAS-L Discussion List [mailto:DCHAS -L**At_Symbol_Here**LIST.UVM.EDU] On Behalf Of Alan Hall
Sent: Friday, Ju ne 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 toxici ty would not change with the salt involved, although there are exc eptions.  For example, when treating hydrofluoric acid (HF) exposu res with calcium salts, the calcium gluconate salt can be used topically , injected intradermally, or given intravenously or interarterially.&nb sp; However, the calcium chloride salt can only be injected intravenous ly, because it causes severe skin damage and sloughing if extravasated fr om a vein or injected intradermally and can cause devastating vascular inju ry if injected intraarterially.  
Calcium salt s are also a good example of the second point.  The dose of the acti ve ingredient can vary significantly with the same volume of different salt s.  In the calcium example, the calcium chloride salt in a given volume will have approximately 3 times more Ca+2 ion that the same vo lume of the calcium gluconate salt.  When treating life-threatening cardiovascular complications of hydrofluoric acid systemic toxicity, it i s therefore often wise to choose the calcium chloride salt for intravenous infusion (with precautions against extravaasation), as a much higher dose of calcium ion can provided with the same volume and the same infusion tim e.
A similar comparison might be made for norepinephrine, but what the relationship of dose is between various salt forms in the same volume, I don't have memorized.
Hope this answers the que stion.
Alan H. Hall, M.D.
President and  Chief Medical Toxicologist
Toxicology Consulting and Medical Translating Services, Inc.
Laramie, WY
Clinical Assistant Profes sor
Colorado School of Public Health
Denver, CO
> ; Date: Thu, 10 Jun 2010 16:30:45 -0500
> From: tsiakals**At_Symbol_Here**ILLINO IS.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? More specifically, is the toxicity of norepinephrine the same as norepinephri ne bitartrate salt?
> Thanks,
> -Nick

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