[1 vial $7.40]
- Calcium chloride
- Hypocalaemia (particularly if there is refractory shock or bleeding)
- ECG abnormalities caused by hyperkalemia (acts as a membrane stabiliser)
- Magnesium toxicity
PRESENTATION AND ADMINISTRATION:
Preferably give via a central line (if this is present)
Injection undiluted solution. 1gm calcium chloride/10ml (i.e. 10% solution). 6.8mmol of calcium per 10ml. Calcium chloride is a clear colourless solution
For direct IV injection, inject undiluted solution at a rate not exceeding 0.5-1ml/min (0.35 – 0.7 mmol of calcium per minute). For intermittent infusion, add 1gm of calcium chloride to 50ml of compatible IV fluid. Administer at a rate not exceeding 0.35-0.7mmol of calcium per minute (50-100mg/min). That is, for a 2% solution the maximum rate range is 2.5-5ml/min
Compatible with the following IV fluids:
D5W, normal saline, glucose and sodium chloride, Hartmanns
Room temperature below 30°C
Usually give one vial and repeat as necessary (note 1 vial of calcium gluconate contains approximately one third of the amount of calcium that is present in a vial of calcium chloride.)
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
- Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
- 0.2ml/kg (max 10ml)
- Digitalis toxicity
- Hyperphosphataemia (do not administer calcium if the Calcium + Phosphate is >5.5; this is an indication for dialysis)
- Calcium chloride should be injected into a large vein very slowly, as it may cause peripheral vasodilatation and a cutaneous burning sensation (it is preferable to administer it centrally if the patient has a central line)
- Avoid IV calcium in patients on digoxin where possible due to the risk of inducing digoxin toxicity.
Calcium chloride injection, 10% is irritating to veins and must not be injected into tissues, since severe necrosis and sloughing may occur. Great care should be taken to avoid extravasation or accidental injection into perivascular tissues.
- Laboratory Tests:
An arterial or venous blood gas should be repeated after administration of calcium chloride to check the ionised calcium.
- Drug/Laboratory Test Interactions:
IMPORTANT DRUG INTERACTIONS FOR THE ICU
- Hypercalcaemia increases the risk of digitalis toxicity. Because of the danger involved in the simultaneous use of calcium salts and drugs of the digitalis group, a digitalized patient should not receive intravenous injections of calcium unless the indications are clearly defined.
- The major side effects are those due to hypercalcaemia as a result of inadvertent over dosing.
Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, and anorexia.
Polyuria, polydipsia, anorexia, weight loss, nocturia, conjunctivitis (calcific), pancreatitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, elevated Cr, albuminuria, hypercholesterolemia, elevated AST and ALT, ectopic calcification, nephrocalcinosis, hypertension, cardiac arrhythmias, dystrophy, sensory disturbances, dehydration, apathy, arrested growth, urinary tract infections, and, rarely, overt psychosis.