Calcium Parenteral Administration

Aka: Calcium Parenteral Administration, Intravenous Calcium, Calcium Replacement, Calcium Chloride, Calcium Gluconate, Calcium Gluceptate

1. See Also
   1. Calcium Supplementation
2. Mechanism of action: Cardiac effect
   1. Calcium is a positive inotrope
      1. Increases force of myocardial contraction
   2. Variable effect on Systemic Vascular Resistance
3. Efficacy
   1. No proven benefit in Cardiac Arrest
4. Indications
   1. Hypocalcemia
      1. Often occurs after Blood Transfusion
   2. Hyperkalemia
   3. Hypermagnesemia
   4. Calcium Channel Blocker Overdose or toxicity
      1. May also prevent hypotensive effect of IV agent
   5. Not indicated in:
      1. Asystole
      2. Pulseless Electrical Activity
5. Preparation
   1. Calcium Chloride (10%): 100 mg per ml
      1. Contains 27.2 mg/ml elemental Calcium
      2. Advantages over Calcium Gluconate
         1. Higher Calcium amount (3x)
         2. Drives predictably higher Serum Calcium levels
            1. Historically preferred in patients with shock
            2. However Calcium Gluconate likely has same efficacy with better peripheral IV safety
         3. Does not require first-pass metabolism
            1. However Calcium Gluconate does not require first-pass metabolism either (despite common dogma)
   2. Calcium Gluconate (10%)
      1. Contains 9 mg/ml elemental Calcium
      2. Less venous sclerosis with infusion than with Calcium Chloride
         1. Preferred agent if only peripheral IV available
   3. Calcium Gluceptate
   4. References
      1. Swaminathan and Herbert (2014) EM:Rap 14(1): 13-14
      2. Martin (1990) Anesthesiology 73(1): 62-5 [PubMed]
6. Dosing: Calcium Gluconate (10%, 0.4 mEq/ml)
   1. Hypocalcemia
      1. Calcium Gluconate 1-2 grams in 50 ml D5W over 1 hour
   2. Emergent dosing
      1. Initial: 2 ampules (20 ml) IV over 10-30 minutes
      2. Maintenance: 60ml in 500ml D5W at 0.5-2.0 mg/kg/h
7. Dosing: Calcium Chloride (10%, 1.4 mEq/ml)
   1. Administer no faster than 0.5 to 1 ml/minute
   2. General indications (e.g. Hyperkalemia)
      1. Child: 0.2 - 0.25 ml/kg given very slowly
      2. Adult: 5-10 ml given very slowly
   3. Prophylaxis of Calcium Channel BlockerHypotension
      1. Initial: 2 - 4 mg/kg IV given very slowly (over >10 minutes)
      2. Repeat as needed every 10 minutes
8. Precautions
   1. Rapid Calcium administration may result in:
      1. Bradycardia
      2. Asystole
   2. Drug Interaction
      1. Digoxin: Digitalis Toxicity
      2. Sodium Bicarbonate: precipitates with Calcium
   3. Coronary vasospasm
   4. Local tissue injury
      1. Peripheral vein sclerosis
      2. Local Chemical Burns if infiltrates into tissue
9. Monitoring while on Calcium Infusion
   1. Follow Calcium levels every 4-6 hours