calcium chloride

High Alert

Treatment and prevention of hypocalcemia.
Emergency treatment of hyperkalemia and hypermagnesemia and adjunct in cardiac arrest or calcium channel blocking agent toxicity.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypercalcemia;
Renal calculi;
Ventricular fibrillation.

Use Cautiously in:

Patients receiving digitalis glycosides;
Severe respiratory insufficiency;
Renal disease;
Cardiac disease.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, bradycardia, CARDIAC ARREST, syncope

GI: constipation, nausea, vomiting

GU: calculi, hypercalciuria

Local: phlebitis

Neuro: headche, tingling

Interactions ⬆ ⬇

Drug-drug:

Hypercalcemia increases the risk of digoxin toxicity.
Chronic use with antacids in renal insufficiency may lead to milk-alkali syndrome.
Ingestion by mouth decreases the absorption of orally administered tetracyclines, fluoroquinolones, phenytoin, and iron salts.
Excessive amounts may decrease the effects of calcium channel blockers.
Decreases absorption of risedronate (do not take within 2 hr of calcium supplements).
May decrease the effectiveness of atenolol.
Concurrent use with diuretics (thiazide) may result in hypercalcemia.
May decrease the ability of sodium polystyrene sulfonate to decrease serum potassium.

Drug-Food:

Cereals, spinach, or rhubarb may decrease the absorption of calcium supplements.
Calcium acetate should not be given concurrently with other calcium supplements.

Availability ⬆ ⬇

Calcium Chloride

Injection: 10% (100 mg/mL) (equivalent to 27.2 mg elemental calcium/mL or 1.36 mEq calcium/mL)

Route/Dosage ⬆ ⬇

1 gram of calcium chloride contains 270 mg elemental calcium (13.5 mEq calcium).

Hypocalcemia (dosed as calcium chloride)

IV (Adults ): —500–1000 mg/dose q 6 hr.
IV (Children ): 10–20 mg/kg/dose, repeat q 4–6 hr as needed.

Cardiac arrest and calcium antagonist toxicity (dosed as calcium chloride)

IV (Adults ): 2–4 mg/kg, may repeat in 10 min if needed.
IV (Children , Infants, and Neonates): 20 mg/kg, may repeat in 10 min if needed. IV infusion: 20–50 mg/kg/hr.

Tetany (dosed as calcium chloride)

IV (Adults ): 1 g over 10–30 min, may repeat after 6 hr.
IV (Children , Infants, and Neonates): 10 mg/kg over 5–10 min, may repeat after 6 hr or continuous infusion up to 200 mg/kg/day.

Action ⬆ ⬇

Essential for nervous, muscular, and skeletal systems.
Maintain cell membrane and capillary permeability.
Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Essential for bone formation and blood coagulation.

Therapeutic effects:

Replacement of calcium in deficiency states.

Classifications ⬆ ⬇

Therapeutic Classification: mineral and electrolyte replacements/supplements

Pharmacokinetics ⬆ ⬇

Absorption: Absorption from the GI tract requires vitamin D. IV administration results in complete bioavailability.

Distribution: Readily enters extracellular fluid. Crosses the placenta and enters breast milk.

Metabolism/Excretion: Excreted mostly in the feces; 20% eliminated by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(effects on serum calcium)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown
IV	immediate	immediate	0.5–2 hr

Patient/Family Teaching ⬆ ⬇

Calcium Supplement: Encourage patients to maintain a diet adequate in vitamin D (see Food Sources for Specific Nutrients).
Osteoporosis: Advise patients that exercise has been found to arrest and reverse bone loss. Patient should discuss any exercise limitations with health care professional before beginning program.

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Indications ⬇