CALCIUM CHLORIDE

Class

Calcium Replacement

Pharmacology and Actions

1. Ca++ is an essential component for proper functioning nervous, muscular, skeletal and endocrine systems
2. Positive inotrope & dromotrope

Indications

1. Hypermagnesemia
2. Low serum calcium level
3. Overdose of calcium channel blockers
4. Hyperkalemic cardiac arrest
5. Tx of insect bites and stings, particularly black widow spiders and scorpions

Contraindications

1. Hypersensitivity to the medication
2. Digoxin toxicity

Precautions

1. Irritation with extravasation (may cause tissue necrosis)
2. Rapid IV administration may cause tingling sensations, a calcium taste, a sense of oppression or “heat waves”
3. Cardiotoxicity and local phlebitis with rapid IV administration
4. Use cautiously in patients with renal insufficiency or history of cardiac disease

Administration

1. Preparation: 1 gm/10 ml preload (100 mg/ml) 10%
2. Adult: 8 - 16 mg/kg (usually 5 - 10 ml) IV/IO for hyperkalemia and calcium channel blocker overdose, prn 2 - 4 mg/kg (usually 2 ml) IV/IO for prophylaxis before IV calcium channel blockers
3. Pediatric: 20 mg/kg (0.2 ml/kg) slow IV/IO push, repeat for documented conditions
4. Administer calcium chloride < 1 ml/min and Calcium gluconate < 2-3 ml/min

Side Effects

1. Hypersensitivity reactions (hypotension, bradycardia)
2. Flushing, nausea, vomiting, drowsiness, ventricular irritability
3. Hypotension, bradycardia, arrhythmias, asystole, VF

Special Considerations

1. Calcium chloride is 3 X more potent than calcium gluconate
2. Antidote for overdose - magnesium sulfate IV