In previous blogs (here and here) I’ve discussed how to construct a murder plot using a drug or medical device that could mimic a heart attack that would be virtually undetectable as a murder—the so-called perfect murder weapon!
But there is yet another equally clever drug (two actually) that can create lethal cardiac events while remaining delightfully elusive to the medical examiner.
Calcium Gluconate is a very useful drug to counteract the effects of hyperkalemia (too much potassium in the body) that can produce heart arrhythmias. Calcium gluconate is available as a sterile solution that’s given intravenously. It’s also used to counteract an overdose of Epson Salts (magnesium sulfate).
Too much injected calcium gluconate, however, initiates lethal electrolytic imbalances that disrupt the normal levels of sodium, potassium and chloride in the body’s cells. These electrolyte imbalances interfere with and slow the heart to dangerously low levels, eventually creating a heart attack. It should be noted that a lethal dose of calcium gluconate can only be achieved with the injectable form since an oral dose is absorbed much too slowly.
The initial symptoms of a toxic dose of calcium gluconate include skin redness or flushing, a sensation of warmth or heat with a possible rash, sweating, nausea and vomiting, a tingling sensation, and an irregular and slow heartbeat.
The impatient murderer might even add a second injection—potassium phosphate. By doing so, the calcium and phosphate in these solutions will interact and form an insoluble bond that creates what’s known as an aggregate anaphylaxis—severe hypertension and right ventricular heart failure. A hint to the murder mystery writer: When calcium gluconate and potassium phosphate solutions are mixed together, they form an insoluble precipitant. Therefore, they must be injected separately to prevent precipitate formation until they’re in the victim’s bloodstream.
When I was a clinical pharmacist, I formulated and prepared intravenous feeding solutions for patients who could not tolerate oral nutrition. I had to make sure that the calcium gluconate and potassium phosphate solutions remained separated by mixing in the calcium gluconate solution as one of the FIRST ingredients and adding the potassium phosphate solution as one of the LAST ingredients so that each was dilute enough in the total mixture so as not to interact and form an insoluble complex that would harm my patients.
Thoughts? Comments? I’d love to hear them!