| CALCIUM CHLORIDe
Classifications: fluid and electrolytic replacement solution; Therapeutic:fluid and electrolyte replacement
Prototype: Calcium gluconate
Pregnancy Category: C
Ionizes readily and provides excess chloride ions that promote acidosis and temporary (12 d) diuresis secondary to
excretion of sodium.
Rapidly and effectively restores serum calcium levels in acute hypocalcemia of various origins and an effective cardiac
stabilizer under conditions of hyperkalemia or resuscitation.
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.
Ventricular fibrillation, hypercalcemia, digitalis toxicity, injection into myocardium or other tissue; pregnancy (category
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
Adult: IV 0.51 g (714 mEq) at 13 d intervals as determined by patient response and serum calcium levels
Child: IV 2.75 mg/kg administered slowly
Neonate: IV <1 mEq/d
Adult: IV 4.516 mEq prn
Child: IV 0.50.7 mEq/kg t.i.d. or q.i.d.
Neonate: IV 2.4 mEq/kg/d in divided doses
Adult: IV 24 mg/kg, may repeat in 10 min
Child: IV 20 mg/kg, may repeat in 10 min
- 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 0.51 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.
Pain and burning at IV
site, severe venous thrombosis, necrosis and sloughing (with extravasation).
May enhance inotropic and toxic effects of digoxin;
antagonizes the effects of verapamil
and possibly other calcium channel blockers
Crosses placenta. Elimination:
Primarily in feces; small amounts in urine, pancreatic juice, saliva, and breast milk.
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 1530 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 1530 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,