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Related post: desired to increase the coagulability of the blood, as in persistent hemor- rhages, aneurism, hemophilia, purpura, etc. However, the normal content of Ca in the blood is more than is required for coagulation; further increase of Ca does not increase the coagulability. The addition of calcium to hemophilic blood in vitro delays rather than hastens its coagulation (Hess, 1915). Nor has it been shown that Ca is deficient in any of these conditions. Hemophilia is not related to calcium deficiency or any Leukeran Chlorambucil anomaly of calcium metabolism. Rather, it is due to deficiency of CALCIUM SALTS 689 prothrombin (Howell, 1914), fibrinogen (Hess, 1914, 1916), or throm- bokinase (Sahli, 1905). Estimations of the coagulation time after admin- istration of Ca have given contradictory results, due partly to differences of technic, partly to the time when the observations were made. The experiments of Velden, 1913, indicate that the coagulability is indeed increased for a short time. This increase is also produced by equal quantities of NaCl, and is probably due to a local action on the alimentary canal. It does not last beyond twenty or thirty minutes, and would therefore be useless. However, since the administration of Ca does no harm, its use may be permissible. Any benefits in purpura (Russel, 1907) could perhaps be explained by its action on the permea- bility of the vessels. With hirudin plasma the coagulation is further delayed by the addition of calcium (Hess, 1915)- Clinical Data. The use of Ca in hemophilia was started by Wright, 1893, who claimed a reduction of the coagulation time to 60 to 70 per cent. Coleman, 1907, found no effect on oral administration, but shortened coagulation time from hypodermic injection. Purely negative results were obtained by Robertson, Illmen and Duncan, 1907; Addis, 1909; Rudolph, 1910; Dale and Laidlaw, 1912; and Hess, 1915. In ob- structive jaundice, when blood coagulation is delayed by excess of bile in the blood, Lee and Vincent, 1915, report restoration of the coagulability by calcium lactate (7 Gm. per day). The theories Chlorambucil Cost of hemophilia Chlorambucil Price are reviewed byHurwitz and Lucas, 1916. Kahn, 1916, reports one case with deficient calcium content of the blood. Other Substances Increasing the Coagulability of the Blood. Gelatin, and kephalin serum are discussed elsewhere (see Index). Velden, 1911, also found increased coagu- lability after the digitalis group, suprarenal extract, and amyl nitrite. Coagulation of Milk. Ca is necessary for the precipitation of the caseinogen as casein. Rigor Mortis. This is hastened by the systemic administration of Ca, delayed by Mg (Meltzer and Auer, 1907). Phlorhizin Diabetes. Jacoby and Rosenbloom, 1915, state that large doses of calcium diminish the excretion of sugar, nitrogen and acetone. The blood-sugar is also lowered, so that presumably the production of sugar is diminished. Administration for Systemic Action. The commonly used salts are calcium chlorid and lactate. The chlorid serves well by mouth, but for hypodermic injections, the less irritant lactate should be preferred; at least, the chlorid should not be used in concentrations above i or 2 per cent, or there will be indurations. The concentration of the lactate should not exceed 5 per cent, since stronger solutions solidify (Hugenholtz, 1915). The single oral dose of Buy Chlorambucil the chlorid is 0.5 to i Gm., 8 to 15 gr., in solution, with meals. The daily dose against serum rash is 0.75 to i Gm., beginning on the day of the antitoxin injection, and continuing for three days after the last injection (Netter, 1909). Against hay fever, hem- orrhage, etc., i to 3 Gm. are given daily, commencing as early as possible and continuing for several weeks. This continued use does not seem to cause harm (Emmerich andLoew, 1913, 1915). The lactate may be given in double this dosage. The hypodermic dose of the lactate is 0.5 to 2 Gm. in 20 to 50 c.c. of water. Intravenous injections have been employed in spasmodic conditions; 2 to 4 Gm. of the chlorid or lactate in a liter of normal saline, injected very slowly. PREPARATIONS CALCIUM *Calcii Carbonas Pracipitatus (Calc. Carb. Praec.), U.S.P., B.P. (Precipitated Chalk), CaCOs. Fine white powder, without odor or taste. Practically insol. in water; decomposed by acids. Dose, i Gm., 15 gr., U.S.P., as powder. This will neutralize 44 690 MANUAL OF PHARMACOLOGY 0.730 Gm. absolute HC1. Larger doses are harmless. Chlorambucil 2mg Dose, B.P., i to 4 Gm., 15 to 60 ' *Creta Praparata (Cret. Praep.), U.S.P., B.P.; Prepared Chalk (Drop Chalk). Native Calcium Carbonate freed from most of its impurities by elutriation. A white to grayish-white, very fine, amorphous powder, often formed into conical drops; odorless and tasteless. Almost insol. in water; insol. in ale. Dose, i Gm., 15 gr., U.S.P.; i to 4 Gm., 15 to 60 gr., B.P. Used extensively in tooth-powders. Mist. Cret., U.S.P., B.P.; Chalk Mixture. The average dose, 15 c.c., 4 drams, contains about 3 Gm. of Comp. Chalk Powder suspended in Cinnamon Water, U.S. P.; 3 per cent, of chalk, B.P. Dose, 15 c.c., 4 drams, U.S.P.; 15 to 30 c.c., % to i ounce, B.P. Pulv. Cret. Co., U.S. P.; Compound Chalk Powder. A mixture of 30 per cent, of Cret. Prsep.; 20 per cent, of Acacia; 50 per cent, of Sugar. Dose, 2 Gm., 30 gr., U.S. P. Pulv. Cret. Arom., B.P. 25 per cent, of Chalk; 50 per cent, of Sugar; with Aromatics. Dose, 0.6 to 4 Gm., 10 to 60 gr., B.P. *Calcii Chloridum (Calc. Chlor.), U.S.P., B.P.; Calcium Chlorid (not to be confused with Chlorinated Lime, miscalled "Chlorid of Lime"), CaCU- White, translucent, hard fragments, or granular; odorless, of sharp saline taste. Very deliquescent, and should therefore not be dispensed in powders, but as solution. Freely sol. in water (i : 1.2) also in ale. (i : 10). Incompatible with carbonates, phosphates and sulphates. Dose, 0.5 Gm., 8 gr., U.S.P.; 0.3 to i Gm., 5 to 15 gr., B.P., diluted. Calcium chlorid occurs with varying quantities of water. The content of CaCl 2 is 100 per cent, in the anhydrous, about 75 per cent, in the fused, and 50 per cent, in the crystals. The U.S. P. specifies a minimum of 75 per cent. The B.P. is dried at 2ooC. *Calcii Lactai (Calc. Lact.), U.S.P., B.P., Ca(C3H 6 O 3 )2 + sH 2 O. White, granular masses of powder, without odor or taste. Sol. in water (i : 20), but very slightly sol. in Chlorambucil Leukeran ale. Dose, 0.5 Gm., 8 gr., U.S. P.; 0.6 to 2 Gm., 10 to 30 gr., B.P. Syr. Calc. Lactophos., U.S. P., B.P. 2.5 per cent, of calcium carbonate dissolved in syrup with lactic and phosphoric acids, U.S. P.; 7.5 per cent, of Calc. Lact. with phosphoric acid, B.P.; orange-flower flavor. Dose, 10 c.c., 2% drams, U.S. P.; 2 to 4 c.c., Yi to i dram, B.P.
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