Edetate Disodium (EDTA)

 Action Forms chelates with polyvalent metals, especially calcium, thus increasing their urinary excretion.

 Indications Emergency treatment of hypercalcemia; control of ventricular arrhythmias associated with digitalis toxicity.

 Contraindications Anuria.

 Route/Dosage

ADULTS: IV 50 mg/kg/day (maximum 3 g/day). Usually administered in 5 consecutive daily doses followed by 2 days without medication, with repeated courses prn, for total of 15 doses. CHILDREN: IV 40 mg/kg/day (maximum 70 mg/kg/day) or 15–50 mg/kg/day (maximum 3 g/day) with 5 days between courses.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Transient drop in BP; adverse effects on myocardial contractility; thrombophlebitis. CNS: Transient circumoral paresthesia; numbness; headache. DERM: Exfoliative dermatitis; toxic skin and mucous membrane reactions. GI: Nausea; vomiting; diarrhea. GU: Nephrotoxicity; damage to reticuloendothelial system. HEMA: Thrombophlebitis; anemia. META: Electrolyte imbalances including hypocalcemia, hypokalemia, and hypomagnesemia; hyperuricemia. OTHER: Febrile reactions.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Special risk patients: Use drug cautiously in patients with limited cardiac reserve or incipient congestive failure. Diabetic patients: Blood sugar and insulin requirements may be lower in insulin-dependent diabetic patients. IV infusion: Rapid IV infusion or high serum concentrations can cause a precipitous and potentially fatal drop in serum calcium. Do not exceed maximum dose or rate.

 Administration/Storage

• Do not confuse edetate disodium with edetate calcium disodium.
• ADULTS: Dissolve 50 mg/kg dose in 500 ml of D5W or 0.9% Sodium Chloride for Injection. Infuse over ³ 3 hr.
• Children: Dissolve drug in sufficient volume of D5W or 0.9% Sodium Chloride for Injection to bring final concentration to £ 3%. Infuse over ³ 3 hr.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note previous history of renal disease or CHF.
• Because of potential for electrolyte disturbances, obtain appropriate laboratory determinations (electrolytes, calcium, renal function test).
• Adequately hydrate patient before administration.
• Assess patency of IV site frequently during therapy.
• Assist patient with ambulation.
• After infusion, have patient remain supine for short period because of possible orthostatic hypotension.
• Assess for allergic reaction: rash, urticaria. Withhold drug and notify physician if these signs occur.
• Monitor vital signs and I&O.
• Monitor rate of infusion closely.
• If signs or symptoms of hypocalcemia occur (circumoral numbness/tingling, positive Chvostek's or Trousseau's signs, tetany), notify physician.
• If signs or symptoms of cardiac dysfunction occur (tachycardia, arrhythmias, hypotension), notify physician.

 Patient/Family Education

• Advise patient to remain recumbent for 30 min after infusion because of possibility of orthostatic hypotension.
• Inform patient that breath may be odorous.