When Did the Pain Go Away?
EDTA Dosage and Osmolarity Calculating Software
By: Ronald M. McGuff, President/CEO McGuff Company, Inc.
October 15, 2008
It is as vivid in my memory today as it was in the spring of 1983. It happened at an American College for Advancement in Medicine (ACAM) Workshop for Chelation Therapy. The topic of discussion, during a question and answer session, was pain upon IV administration and what could be done to minimize it. The usual conversations revolved around how much lidocaine or procaine should be infused to obtain relief of venous irritation caused by the administration of the chelating agent(s). Everyone knew about the pain and just about everyone was using some amount of lidocaine or procaine to mask the problem. It was during this discussion that a physician, new to ACAM and chelation, stood up and asked the panel if anyone had looked into the osmolarity of the IV solutions being administered to patients. Was this the cause of the patient’s venous irritation? This simple question caught everyone off guard as no one in the room had any idea what the osmolarity of the chelating solution was. Thus began the McGuff Company’s (McGuff) involvement to help ACAM physicians understand carrier solution osmolarity, ingredient osmolarity, pain and safety of IV solutions.
McGuff, working together with the leaders and innovators of ACAM, determined that venous irritation was caused in part by the administration of significantly hypertonic IV solutions. We all shared the same concern that patients should receive a chelating solution as close to isotonic as possible. Through hard work and the combined efforts of our manufacturers, chemists and pharmaceutical laboratory and with the collaboration of many ACAM physicians, McGuff was able to publish the first osmolarity table for alternative medical care in time for the fall 1983 chelation workshop and meeting. While the table only provided information on twenty-eight small volume parenterals, it was a significant step forward and culminated in the use of Sterile Water for Injection replacing Lactated Ringer’s Solution.
Over the years our tables improved allowing physicians to calculate, modify and perfect the osmolarity of most any given IV solution before patient infusion. Reduction or the elimination of pain associated with IV chelation allowed for better patient compliance. Patients were now willing to complete treatment sets of twenty to thirty infusions without dropping out of the program because of discomfort.
In 1984, McGuff set another milestone by providing osmolarity calculating software for personal computers. This program was created in DOS and ran from a 1.44MB floppy disk. This is hard to imagine by today’s standards but a significant achievement in 1984. For the first time physicians could quickly and accurately manipulate unique IV protocols to provide safe, therapeutic IV solutions to patients.
In 1989, ACAM formally adopted the Protocol for the Safe and Effective Administration of Chelation Therapy which provided, for the first time, an agreed upon protocol defining EDTA dosage using the Cockcroft – Gault Equation (as modified) and a patient’s lean body weight. McGuff immediately recognized the advantage of using software to make the dosage decision simple, efficient and reliable. McGuff created the EDTA dosage calculation software and bundled it with our popular osmolarity calculating software to support the rapid and reliable calculation of EDTA dosage and osmolarity.
Over the years many enhancements to the EDTA Dosage and Osmolarity Calculating Software have been made including the calculation of Sodium of the given IV protocol. Tables, reports, and charts have also been added to provide the physician a clear understanding of how to properly create a safe IV infusion protocol.
Today, the McGuff EDTA Dosage and Osmolarity Calculating Software has proven to be a significant success and is used by progressive physicians in the United States and countries around the world. Additionally, McGuff has several contractual relationships to provide our software to medical schools to improve understanding of the relationship of admixtures, osmotic pressures and IV carrier solutions.
The McGuff Company, ACAM physicians and thousands of patients owe a lot to the one lone unnamed physician who stood up during a question and answer session and asked “what is the osmolarity?”
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