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