DR.
CRANTON'S WRITTEN ORDERS FOR NURSES TO
ADMINISTER
INTRAVENOUS EDTA CHELATION THERAPY
Patient Name
______________________________________
Date ______________
1.
Measure body weight, blood pressure and pulse with each infusion.
2. Serum creatinine is to be
drawn prior to each third infusion if EDTA chelation is infused from one or
two times per week. Measure
serum creatinine with each infusion if EDTA is infused 3 or more times per
week, if prior serum creatinine was previously above the normal range or if
an upward trend has been noted.
3.
Notify physician before starting infusion of any
consistent upward trend of serum creatinine toward or above the upper limits
of the reference range.
4.
Urine analysis (dip) will be done with each
infusion. Notify physician of
any suspected abnormalities.
5.
Notify physician of any weight gain of more than
5 lbs. since last infusion, diastolic BP >100, or systolic >160.
6.
Notify physician of any unusual situation.
7.
If weakness or dizziness occur during infusion, elevate feet and
lower head of patient. If symptoms persist, substitute normal saline for EDTA
infusion, draw blood for calcium and electrolytes, measure whole blood
glucose with glucometer, monitor frequent vital signs and notify physician
.
8.
Ensure that juice and other nutritious snacks are available for any
patient who might develop symptoms of hypoglycemia, or has not eaten within
3 hours prior to each infusion.
9.
Inquire of each patient about improvements, complications, or
symptoms following or since their last infusion.
Record in chart and notify physician of any significant changes.
10.
Notify physician of patients who routinely take
Lasix (furosemide) or any other diuretic for congestive heart failure who
shows signs of dependent edema or shortness of breath. If physician’s
orders furosemide by intravenous push, administer slowly over 2 minutes at
the beginning of chelation EDTA infusion in the same IV tubing.
11.
The chelation staff will be thoroughly familiar with the provisions
of the PROTOCOL FOR ADMINISTRATION of EDTA CHELATION THERAPY,
published as chapter 32 in the
Textbook on EDTA chelation Therapy, Second Edition. A copy will be present in the physician’s
office, and at the nurse’s
station.
12.
Compute the dose of EDTA for each infusion using
the formula according to instructions below.
(click her for formula) A computer
program is available in the clinic to simplify these computations.
After the 3rd infusion, if serum creatinine has been within the reference
range relatively stable (plus or minus 20%), each subsequent infusion may be
mixed and started using the average of the prior several creatinine
measurements. If serum
creatinine shows an upward trend, mix and start the next infusion using a
revised dose, computed using the current serum creatinine.
Serum creatinine measurements should be performed before each
infusion if an upward trend is noted.
In no event will the dose of EDTA exceed 3 Grams without specific
Physician’s orders.
13.
Unless previously modified by physician, mix each
EDTA infusion bottle according to instructions below.
14.
If a "clear solution" is ordered by the physician
for a patient who might show intolerance or allergy to one of the customary
ingredients, use an isotonic carrier solution of normal saline or 5%
dextrose in water, according to
instructions below.
(click here for detail)
15.
Remind patients to continue taking their daily
nutritional supplements to prevent depletion by chelation therapy and to
enhance overall benefits. Document supplement copmpliance in chart, and
notify the physician of non-compliance.
Inquire of about any change in prescription medicines and
record any change in their chart. Remind patients to not take trace element
supplements on the day of chelation until after the chelation treatment.
Physician's
signature____________________________________Date______________
STANDARD PROTOCOL
FOR MIXING EDTA
BOTTLES
- Sterile Water, 500cc. REMOVE 60cc to make room for added
ingredients.
- EDTA, 150mg/ml. Dosage computed according to creatinine level using
the protocol formula.
- Sodium Bicarbonate, 1 mEq/ml, 20 ml = 20 meq
- Vitamin C, 6 ml, 500 mg/ml, 3.0 gm (no preservative, up to 10.0 gm
is used by some physicians) .
- MgSulfate, 500 mg/ml (no preservative), 5.0 ml = 2.5 gm
- Heparin, 0.25 ml of 10,000 u/ml, = 2500 units total.
- Folic Acid, 0.25ml 1 0mg/mL, = 2.5 mg total.
- Pyridoxine (vitamin B-6), 0.5 ml, 100mg/ml, = 50mg total.
- Cyancobalamin of hydroxycobalamin (vitamin Bl2), 1 ml, 1000mcg/ml,
= 1000mcg total.
- B-Complex-100, 1 ml (optional, not always available).
- Lidocaine HCL, for IV infusion, 2%, 20mg/ml, = 200mg total (no
preservative).
---------------------------------------------
Clear Solution
When patients experience side effects ( headache,
itching, fatigue, etc.) following chelation therapy, a hypoallergenic "clear
solution" can be used for subsequent treatments. This formula might also be
used from the outset for patients who are known to be chemically sensitive.
It is called the "clear solution" because it has has no colored tint from
B-vitamins. A carrier solution Isotonic Normal Saline or 5% Dextrose in
Water (D5W) is used. Remove 30cc, and then add only four ingredients: 1) the
computed dose of EDTA, 2) MgSO4, 3) Sodium Bicarbonate, and 4) Lidocaine,
with the strengths and amounts for those four ingredients as listed above.
Simplified protocol for doctors
outside the USA
or otherwise with limited access to all ingredients listed above:
For several decades, from the early 1950s through the mid 1980s,
EDTA chelation therapy consisted very simply of 3.0 grams disodium-EDTA,
infused over three hours in a 500 ml isotonic solution of either 5
percent dextrose in water, normal saline, or Ringer’s lactate solution.
Lidocaine was added to prevent pain at the infusion site. A
multiple vitamin supplement was given by mouth. For treatment of
patients with relatively normal renal function, that simplified protocol
worked very well. All published reports for many years consistently
documented both the safety and effectiveness of EDTA chelation therapy
in the treatment of atherosclerosis and other age-related diseases were
performed using this simple protocol. The active ingredient is
disodium-EDTA. The goal is to get the prescribed dose of disodium-EDTA
into the patient slowly over 3 hours without discomfort. All else is an
embellishment and adds little. Calcium-EDTA may provide partial benefit,
but disodium EDTA (without calcium) is the only form of EDTA proven
fully effective in 50 years of study and millions of treatments.
COCKCROFT-GAULT EQUATION, MODIFIED FOR DOSE OF
EDTA
This formula will result in
approximately the same blood level of EDTA throughout the IV infusion for
all patients by adjusting for the effects of age, sex, body size and
composition and kidney clearance rate.
_________________________
Glomerular Filtration Rate Computation
CrCl
=
(140
-
Age)
X (LBW
X
1.33)
(72
X
Cr)
CrCl = computed Creatinine Clearance, approximating
renal glomerular filtration rate in ml/min
Age =patient's age
LBW = computed lean body weight in Kg, see below.
Cr = serum creatinine in mg/dL
For CrCl in women, multiply the above result by 0.85
_________________________
EDTA DOSE TO BE ADMINISTERED IN EACH
INFUSION IS COMPUTED AS
50 mg EDTA per Kg
(LBW X 1.33) X (CrCl/100)
The dose is usually limited to a maximum of 3.0 grams
(widely accepted as the fully effective dose).
Computed doses between 3.0 and 5.0 grams
are sometimes individualized with careful patient evaluation.
Correct for CrCl/100 only if computed creatinine
clearance is less than 100 ml/min.
Maximum rate of infusion is 16.6 mg/min X
CrCl/100, relative to 70 kg of actual body weight.
_________________________
LEAN BODY WEIGHT (LBW) IN KG AS USED
IN ABOVE COMPUTATIONS
Lean body weight for males is computed at
50 kg plus 2.3 kg for each inch of height over 5 feet.
Lean body weight for females is computed at 45.5 kg
plus 2.3 kg for every inch of height over 5 feet.
Actual weight is used whenever actual weight is less
than computed lean body weight.
CLICK HERE For a Microsoft
Excel Macro that calculates EDTA Dose using the protocol described above.