ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Calcium Chloride
ICU INDICATIONS:
-
Hypocalaemia (particular if there is refractory shock or bleeding)
-
ECG abnormalities caused by hyperkalaemia (acts as a membrane stabiliser)
-
Magnesium toxicity
PRESENTATION AND ADMINISTRATION:
IV:
Preferably give via a central line (if this is present)
Injection of undiluted solution of 1 gm calcium chloride in 10 mL (i.e. 10% solution). Contains 6.8 mmol of calcium per 10 mL. Calcium chloride is a clear colourless solution
For direct IV injection, inject undiluted solution at a rate not exceeding 0.5-1 mL/min (0.35 – 0.7 mmol of calcium per minute). For intermittent infusion, add 1 gm of calcium chloride to 50 mL of compatible IV fluid. Administer at a rate not exceeding 0.35-0.7mmol of calcium per minute (50-100 mg/min). That is, for a 2% solution the maximum rate range is 2.5-5 mL/min.
Compatible with the following IV fluids:
5% dextrose, normal saline, glucose and sodium chloride, Hartmanns
Store at room temperature below 30°C
DOSAGE:
IV:
Give 1 gm (1 vial of 10 mL) and repeat as necessary
Note: 1 vial of calcium chloride contains approximately three times the amount of calcium that is present in one vial of calcium gluconate
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
0.2 mL/kg (max 10 mL)
CLINICAL PHARMACOLOGY:
Calcium
CONTRAINDICATIONS:
-
Hypercalcaemia
-
Digitalis toxicity
-
Hyperphosphataemia (do not administer calcium if the Calcium + Phosphate is >5.5: this is an indication for dialysis)
WARNINGS:
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 risk of inducing digoxin toxicity
PRECAUTIONS:
General:
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:
None known
IMPORTANT DRUG INTERACTIONS IN 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 digitalised patient should not receive intravenous injections of calcium unless the indications are clearly defined
ADVERSE REACTIONS:
The major side effects are those due to hypercalcaemia as a result of inadvertent over dosing
Early:
Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, and anorexia.
Late:
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