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Calcium Chloride

Classification

Electrolyte

Indications

ACP: Cardiac arrest due to suspected hyperkalemia (e.g., renal failure, diabetic ketoacidosis)

ACP: Suspected hyperkalemia with cardiovascular toxicity (e.g., wide QRS complexes, peaked T waves, or hemodynamic instability)

ACP: Calcium channel blocker overdose with symptomatic bradycardia or hemodynamic instability

Calcium shall not be routinely given in cardiac arrest in the absence of evidence of hyperkalemia

Contraindications

Hypersensitivity to calcium chloride
Primary or secondary hypercalcemia

Adult dosages

ACP: All indications

1-2 g IV infusion over 10 minutes
- NB: May be given IV push in cardiac arrest
May repeat once in 10 minutes if indications are still present

Pediatric Considerations And Dosing

Follow weight-based dosing

ACP: Cardiac arrest

20 mg/kg IV over 3 minutes; maximum single dose of 1 g
May repeat once in 10 minutes if indications are still present

ACP: All other causes

10 mg/kg IV over 15 minutes; maximum single dose of 1 g
May repeat once in 10 minutes if indications are still present

Mechanism Of Action

Calcium is essential for a wide range of biological processes, including nerve conduction, muscle contraction, renal function, and coagulation. Administration of calcium in the out-of-hospital context is intended to improve myocardial contractility and ventricular automaticity.

Pharmacokinetics

Intravenous:

Onset: 5-15 minutes
Duration: dose dependent (effects may persist up to 4 hours)

Adverse Effects

Tissue irritation is the most common side effect of calcium administration
Hypotension, cardiac arrhythmias, and cardiac arrest may occur if calcium is given too quickly
Calcium chloride may precipitate or worsen acidosis, cor pulmonale, or renal and respiratory diseases

Warning And Precautions

Do not administer calcium IM or SC. Extravasation of calcium can cause tissue necrosis.

Drug Interactions

Flush IV lines well prior to or following sodium bicarbonate administration to avoid development of calcium carbonate precipitate.
Patients taking digoxin and receiving calcium are at elevated risk for the development of arrhythmias.