CALCIUM CHLORIDE

CALCIUM CHLORIDe Classifications: fluid and electrolytic replacement solution; Therapeutic:fluid and electrolyte replacement Prototype: Calcium gluconate Pregnancy Category: C

Availability

10% injection

Action

Ionizes readily and provides excess chloride ions that promote acidosis and temporary (1–2 d) diuresis secondary to excretion of sodium.

Therapeutic Effect

Rapidly and effectively restores serum calcium levels in acute hypocalcemia of various origins and an effective cardiac stabilizer under conditions of hyperkalemia or resuscitation.

Uses

Treatment of cardiac resuscitation when epinephrine fails to improve myocardial contractions; for treatment of acute hypocalcemia (as in tetany due to parathyroid deficiency, vitamin D deficiency, alkalosis, insect bites or stings, and during exchange transfusions), for treatment of hypermagnesemia, and for cardiac disturbances of hyperkalemia.

Contraindications

Ventricular fibrillation, hypercalcemia, digitalis toxicity, injection into myocardium or other tissue; pregnancy (category C).

Cautious Use

Digitalized patients; sarcoidosis, renal insufficiency, history of renal stone formation; cardiac arrhythmias; dehydration; diarrhea; cor pulmonale, respiratory acidosis, respiratory failure; lactation.

Route & Dosage

All doses are in terms of elemental calcium: 1 g calcium chloride = 272 mg (13.6 mEq) elemental calcium Hypocalcemia Adult: IV 0.5–1 g (7–14 mEq) at 1–3 d intervals as determined by patient response and serum calcium levels Child: IV 2.7–5 mg/kg administered slowly Neonate: IV <1 mEq/d Hypocalcemic Tetany Adult: IV 4.5–16 mEq prn Child: IV 0.5–0.7 mEq/kg t.i.d. or q.i.d. Neonate: IV 2.4 mEq/kg/d in divided doses CPR Adult: IV 2–4 mg/kg, may repeat in 10 min Child: IV 20 mg/kg, may repeat in 10 min

Administration

Intravenous IV administration to neonates, infants, and children: Verify correct IV concentration and rate of infusion with physician. PREPARE: Direct: May be given undiluted or diluted (preferred) with an equal volume of NS for injection. Solution should be warmed to body temperature before administration.   ADMINISTER: Direct: Give at 0.5–1 mL/min or more slowly if irritation develops. Avoid rapid administration. Use a small-bore needle and inject into a large vein to minimize venous irritation and undesirable reactions.   INCOMPATIBILITIES Solution/additive: Amphotericin B, chlopheniramine, dobutamine, concentration-dependent incompatibility with other electrolytes. Y-site: Amphotericin B cholesteryl complex, propofol, sodium bicarbonate.

Adverse Effects (≥1%)

Body as a Whole: Tingling sensation. With rapid IV, sensations of heat waves (peripheral vasodilation), fainting, CV: (With rapid infusion) hypotension, bradycardia, cardiac arrhythmias, cardiac arrest.. Skin: Pain and burning at IV site, severe venous thrombosis, necrosis and sloughing (with extravasation).

Interactions

Drug: May enhance inotropic and toxic effects of digoxin; antagonizes the effects of verapamil and possibly other calcium channel blockers.

Pharmacokinetics

Distribution: Crosses placenta. Elimination: Primarily in feces; small amounts in urine, pancreatic juice, saliva, and breast milk.

Nursing Implications

Assessment & Drug Effects

• Monitor ECG and BP and observe patient closely during administration. IV injection may be accompanied by cutaneous burning sensation and peripheral vasodilation, with moderate fall in BP.
• Advise ambulatory patient to remain in bed for 15–30 min or more depending on response following injection.
• Observe digitalized patients closely since an increase in serum calcium increases risk of digitalis toxicity.
• Lab tests: Determine serum pH, calcium, and other electrolytes frequently as guides to dosage adjustments.

Patient & Family Education

• Remain in bed for 15–30 min or more following injection and depending on response.
• Symptoms of mild hypercalcemia, such as loss of appetite, nausea, vomiting, or constipation may occur. If hypercalcemia becomes severe, call health care provider if feeling confused or extremely excited.
• Do not use other calcium supplements or eat foods high in calcium, like milk, cheese, yogurt, eggs, meats, and some cereals, during therapy.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug