DR. CRANTON'S WRITTEN NURSE'S ORDERS
FOR CHELATION THERAPY
1. Ask initially of each patient and record in patient's clinic chart any changes, complications, or change in symptoms since the last treatment.
2. Measure patient's weight, blood pressure and heart rate before each infusion.
3. Measure and record serum or plasma creatinine (Roche Reflotron® finger-stick technique is adequate):
● Before the first 3 infusions;
● Before every 3rd infusion thereafter if stable;
● When any creatinine measurement is ≥ 1.6 mg/dL or a consistent upward trend is noted. Measure creatinine before every treatment thereafter, notify clinician in charge and document in the chart.
● Notify clinician in charge of any significant changes or abnormalities.
4. Urine analysis (dip) to be done before each infusion. Notify clinician in charge of any significant changes or abnormalities.
5. Notify clinician in charge of any weight gain of more than 5 lbs. since last infusion, of if diastolic BP >100 mm/Hg, or systolic BP >160 mm/Hg, or any other unusual situation.
6. If weakness or dizziness occur during infusion, slow the infusion rate (just enough to keep the vein open), elevate feet and lower head of patient. Notify clinician in charge. If symptoms persist, substitute normal saline for EDTA infusion, measure whole blood with a finger-stick Glucometer, monitor and record vital signs frequently, draw and save blood in case additional laboratory testing is later desirable. If blood glucose is < 60 mg/dL ask the patient to drink 6 to 8 ounces of juice (kept available by the clinic for this purpose). For more profound hypoglycemia, administer a slow IV push of up to 50 ml of 50% glucose solution.
7. Keep juice and small other nutritious snacks available for any patient who might develop symptoms of hypoglycemia, or has not eaten within 3 hours prior to treatment.
8. Notify clinician in charge of any patient who routinely takes Lasix®(furosemide) or any other diuretic to treat congestive heart failure and who shows signs of increasing pedal edema, unusual weight gain, or shortness of breath. If furosemide injection is ordered by clinician in charge, push the ordered dose slowly into the IV tubing at a rate not to exceed 10 mg/min. (If patient reports a sulfa allergy, ask if furosemide has been tolerated in the past.)
9. Compute the dose of EDTA for each treatment using the modified Cockcroft-Gault equation. A Microsoft Excel computer program is available in the clinic to simplify this computation. After the 3rd infusion, if serum creatinine has been relatively stable (plus or minus 20%), each subsequent infusion dose should be computed using the highest of the previous two creatinine values. If serum creatinine shows a consistent upward trend, mix and start the next infusion using a revised dose computed using the most recent creatinine. Creatinine measurements should be performed before each infusion if a consistent upward trend has been noted in the past, or if the baseline creatinine was ≥ 1.6 mg/dL. The dose of EDTA should never exceed 3 grams, and the infusion rate should be kept slow (infused over at least 3 hours or longer).
10. Unless previously modified by the clinician in charge,
mix each EDTA infusion bottle according to the list below.
11. When started, apply tape tape to the side of the bottle, and write a line at the starting level, with time at start, and also mark one third and two thirds of the way toward empty, writing a projected time at one hour and two hours from the start. Monitor carefully during the infusion to maintain desired infusion rate.
12. Update any changes in patient's medication list if
greater than one month since last update, or if there any reason to suspect
a medication change.
Clinician Signature _______________________________Date ___________
INGREDIENTS OF THE EDTA CHELATION INFUSION BOTTLE
1. Carrier Solution: 5% Dextrose in Water (D5W), 500cc. Remove 20 ml to make room for added ingredients. If it is a 1,000 ml bottle, remove 520 ml)
2. Disodium EDTA, 15% solution, (150 mg/mL) Dosage to be computed according to the modified Cockcroft-Gault formula (Microsoft Excel Macro). Do not use Calcium EDTA.
3. Lidocaine, 200 mg
THE FOLLOWING INGREDIENTS ARE OPTIONAL AND ARE NOT NECESSARY AS FOR CHELATION THERAPY TO BE FULLY EFFECTIVE
4. Sodium bicarbonate (with no preservative), 20 meq, may help discomfort
5. Heparin 2,400 to 5,000 units
6. Folic Acid, 1 mg
7. Cyanocobalamin (Vitamin B-12), 1 mg
8. Additional lidocaine as needed for
(40 mg slow infusions directly into the IV tubing, total lidocaine
not to exceed 400 mg in 24 hours)
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Note: In the recent past, vitamin C (ascorbate) has often been added to the EDTA infusion bottle. Laboratory studies show that when ascorbate is combined with EDTA in solution it can trigger a Haber-Weiss cycle with an ascorbate-driven Fenton reaction. That reaction can convert ascorbate from an anti-oxidant to a pro-oxidant when infused into the body’s iron-rich circulation. Such a reaction would increase production of hydroxyl-radicals, superoxide radicals, and hydrogen peroxide in the body, resulting in continuous redox-cycling reactions between iron, oxygen, EDTA, and ascorbate. Such an event could accelerate cell death−just the opposite of what is intended. For that reason, it is recommended that intravenous vitamin C (ascorbate) not be added to the EDTA mixture, but be administered orally or separately from EDTA.
Virtually all of the
published clinical trials achieved very excellent results using only the
first three ingredients listed above in bold type. No improvement has been
reported from additional ingredients. To the contrary, careful observation
and analysis of data since that time indicate that improvement was reduced.
IN CASE OF DISCOMFORT AT OR ABOVE THE IV SITE
1. Check IV site for signs of infiltration. If infiltrated, try to adjust or restart the IV if necessary.
2. If IV has not infiltrated, wrap a warm heating pad around the IV site.
3. If pain persists, slowly inject 40 mg of lidocaine into IV tubing at the infusion site over a one mine period. This can be repeated but the total amount of lidocaine should not to exceed 400 mg in 24 hours. Additional sodium bicarbonate may also help.
If a patient is unduly sensitive and has consistent pain during infusions, 300 mg of lidocaine may be routinely added to each bottle for subsequent treatment.
4. If discomfort is not resolved within 10 minutes, notify clinician in charge.
5. If a patient has consistent or significant side effects from or following treatments (i.e., headache, fatigue, itching, etc.), it can be helpful to use only ingredients numbered 1. through 3. above (only EDTA and lidocaine in the carrier solution), avoiding ingredients numbers 4 through 8. Some patients are chemically sensitive to ingredients 4 through 8, and treatments may need to be individualized.
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The below 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.
NOTE WELL: For more than 35 years, from the early 1950s through the late 1980s, EDTA chelation therapy consisted of only disodium-EDTA, infused slowly over three hours, in a 500 ml carrier solution like 5% dextrose in water or saline. Lidocaine was added to prevent pain. Low potency vitamin supplements without metallic trace elements were sometimes given by mouth. That simple protocol worked very well and was used in all of the many published clinical studies that consistently reported both safety and effectiveness in the treatment of atherosclerosis and other age-related diseases. All of the clinical studies on this website (and republished in the Textbook on EDTA Chelation Therapy) were from data on patients treated with that simple protocol.
The active ingredient in chelation therapy is disodium-EDTA (not calcium EDTA). The goal is to infuse the prescribed dose of disodium-EDTA into the patient slowly over 3 hours, without discomfort. EDTA passes out of the body so rapidly that a slow rate of infusion is probably more important than the total dose of EDTA, just as the amount of time dirty clothes spend in a washing machine can be more important that the amount of soap added to the wash. All other ingredients added to the chelation protocol since that time have only been embellishments and are not necessary for good benefit, as proven by the many published reports showing great benefit using the simple protocol of earlier years. Calcium-EDTA may provide partial benefit, but disodium EDTA (without calcium) is the only form of EDTA shown to be effective in the treatment of atherosclerosis over many years, as used in many published clinical studies No clinical studies have ever been done that show benefit for arterial disease using calcium EDTA.
It has been Dr. Cranton's clinical observation in over the 40 years of practice, using many different protocols, that the simple protocol used in early years was equally as effective, and, in his opinion, even more effective than more complex infusion mixtures adopted since that time.
COCKCROFT-GAULT EQUATION, MODIFIED FOR DOSE OF EDTA
The below formula will maintain approximately the same systemic blood level of EDTA throughout the IV infusion for all patients by adjusting for the effects of age, sex, body size and composition on reduced kidney clearance rate. The half life of EDTA in the body is less than one hour, and the rate of infusion must be kept constant for a lower rate of kidney clearance in smaller, older and ill patients.
Glomerular Filtration Rate
(this method is quite accurate and does not require a 24-hour urine collection)
CrCl = (140 - Age) X (LBW
(72 X Cr)
CrCl = computed Creatinine Clearance, approximating renal glomerular filtration rate in ml/min
Age = =patient's age in years
LBW = computed lean body weight in Kg, see below.
Cr = serum creatinine in mg/dL
iWomen, to correct CrCl for women, multiply the above result by 0.85
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COMPUTATION FOR TOTAL DOSE INFUSED WITH EACH TREATMENT
DOSE = 50 mg EDTA per [ (Kg LBW X 1.33) X (CrCl/100) ]
The maximum dose is limited to a 3.0 grams, which is reported to be the fully effective and safe dose.
Correct by CrCl/100 only if the above computed creatinine clearance is less than 100 ml/min.
Using this formula the maximum rate of infusion will be
16.6 mg/min (adjusted for X CrCl/100), relative to 70 kg of lean body weight.
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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.http://drcranton.com/chelation/downloads/terms_and_conditions.htm
Copyright © 2012 Elmer M. Cranton, M.D., all rights reserved