Hypocalcaemia and a low cardiac output after intravenous codeine phosphate injection: need for an additional mechanism to remove ionized calcium
Bibliographic record
Abstract
A severe degree of hypotension in children followed the intravenous administration of codeine phosphate in several case reports—histamine release was its presumed root cause [1–3]. We also report cardiovascular collapse following accidental bolus intravenous injection of 30 mg (74 μmol) codeine phosphate, but it was associated with a surprising profound degree of hypocalcaemia. A quantitative analysis is provided along with a novel hypothesis to explain the timing and the profound degree of hypocalcaemia that followed the administration of codeine phosphate. We extend this observation to the initiation of kidney stone formation. The conundrum is that while calcium oxalate deposits grow progressively to form Randall's plaque, calcium oxalate does not precipitate in vitro at prevailing concentrations of ionized Ca2+ and oxalate [4]. Since the nidus of the commonest type of kidney stone, calcium oxalate, is hydroxyapatite, it has been postulated that this nidus permits the precipitation of calcium oxalate [5]. However, it is not known how the initial deposit of hydroxyapatite can occur on the basolateral aspect of the ascending thin limb of the loop of Henle in the inner medulla in patients with idiopathic hypocalciuria. We speculate that the first deposit is a precipitate of calcium carbonate (CaCO3).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".