Calcium Chloride

Trade Name

Apo-Cal (CAN), Calcite 500, Caltrate, Chooz, Equilet, Os-Cal, Oyst-Cal, Oystercal, Tums

Mechanism

Ca2+ supplement and replacement

Action

• maintains cell membrane and capillary permeability
• activates nerve impulses and contraction of cardiac muscles

ECC Relavence

• Not to be given with Cross Clamp is on due to risk of stone heart

Dosage

On CPB

• 500mg - 1g (bolus, given slow)

For Life-threatening Cardiac Arrhythmias Associated with Hyperkalemia, Hypermagnesemia, Ionized Hypocalcemia, or Calcium Antagonist Toxicity (e.g., verapamil toxicity), During Cardiopulmonary Resuscitation (off-label)

• Adults
  • 1,500 to 3,000 mg (15 to 30 mL of a 10% solution) IV over 2 to 5 minutes; may repeat if needed.\

• Infants, Children, and Adolescents
  • 60 to 100 mg/kg/dose (Max: 3 g/dose) IV or Intraosseous (0.6 to 1 mL/kg); may repeat if needed.

• Neonates
  • 60 to 100 mg/kg/dose IV or Intraosseous (0.6 to 1 mL/kg); may repeat if needed.

For Transfusion-Induced Hypocalcemia Prophylaxis/ Citrated Blood Transfusion-Induced Hypocalcemia Prophylaxis (off-label)

• Intravenous dosage
  • Adults
    • 300 mg (approximately 1.4 mEq elemental calcium) IV for each 100 mL of citrated blood infused has been recommended.
  • Infants, Children, and Adolescents
    • 300 mg (approximately 1.4 mEq elemental calcium) IV for each 100 mL of citrated blood infused has been recommended.

Intravenous Dosage For the Treatment of Hypocalcemia (including tetany due to hypocalcemia)

• Adults
  • 1 to 2 g IV given over 10 to 60 minutes.
  • May repeat every 6 hours as needed, as determined by serum calcium concentrations and patient response.
  • Doses as high as 4 g IV infused over 4 hours have been used. Alternatively, a continuous infusion of 5 to 21 mg/kg/hour calcium gluconate (0.5 to 2 mg/kg/hour elemental calcium) IV may be administered if symptoms recur after initial IV calcium replacement. Titrate dose based on serum calcium concentrations.

• Infants, Children, and Adolescents
  • Initial bolus of 100 to 200 mg/kg/dose IV given over 10 to 60 minutes (Max: 2 g/dose).
  • May repeat bolus every 6 hours as needed, as determined by serum calcium concentrations and patient response. Alternatively, a continuous infusion of 5 to 21 mg/kg/hour calcium gluconate (0.5 to 2 mg/kg/hour elemental calcium) IV may be administered if symptoms recur after initial IV calcium replacement.
  • Titrate dose according to serum calcium concentrations.

• Neonates
  • An initial bolus of 100 to 200 mg/kg/dose IV given over 10 to 60 minutes.
  • May repeat bolus every 6 hours as needed, as determined by serum calcium concentrations and patient response. Alternatively, a continuous infusion of 5 to 32 mg/kg/hour calcium gluconate (0.5 to 3 mg/kg/hour elemental calcium) IV may be administered if symptoms recur after initial IV calcium replacement.
  • Titrate dose according to serum calcium concentrations. In neonates, continuous infusion of calcium is preferred to IV bolus doses.

Acute, symptomatic:

• Manufacturer's labeling: 200 to 1,000 mg every 1 to 3 days

Severe, symptomatic (eg, seizure, tetany):

• 1,000 mg over 10 minutes; repeat every 60 minutes until symptoms resolve (French 2012)

Indications

• Ca2+ replacement
• VF
• Ca2+ blocker toxicity
• Mg2+ toxicity
• tetany
• hypophosphatemia in ESRD

Adverse Reactions

• Known or suspected digoxin toxicity; not recommended as routine treatment in cardiac arrest (includes asystole, ventricular fibrillation, pulseless ventricular tachycardia, or pulseless electrical activity)
• Bradycardia
• Arrythmias
• Cardiac Arrest

Contraindications

• Hypercalcemia
• Cardiac arrhythmias, digitalis toxicity, ventricular fibrillation
• Extravasation, intramuscular administration, subcutaneous administration
• Premature neonates, renal failure, renal impairment
• Hyperparathyroidism, vitamin D toxicity
• Hypercalciuria, nephrolithiasis
• Sarcoidosis
• Pregnancy
• Breast-feeding