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CALCIUM CHLORIDE (CaCl) 10%
Class/Mechanism of Action
• Calcium Salt, Electrolyte Supplement
Moderates nerve and muscle contractility via action potential excitation threshold regulation.
Indications
• Labeled Indications
˚ Treatment of hypocalcemia and conditions secondary to hypocalcemia (e.g., tetany, seizures,
arrhythmias); treatment of hypermagnesemia; massive transfusion prophylaxis
• Off-Label Indications
˚ Calcium channel blocker toxicity; beta-blocker toxicity (refractory to glucagon and high-dose
vasopressors); severe hyperkalemia (K+ >6.5mEq/L with toxic ECG changes); malignant
arrhythmia (including cardiac arrest) associated with hypermagnesemia
Contraindications
• Known or suspected digoxin toxicity
• Not recommended as routine treatment in cardiac arrest (includes asystole, ventricular fibrillation,
pulseless ventricular tachycardia, or pulseless electrical activity)
• Hypercalcemia
Adverse Reactions/Precautions
• Hypokalemia: Use with caution in patients with severe hypokalemia. Acute rises in calcium can cause
lifethreatening arrhythmias.
• Rapid push can cause arrhythmia, bradycardia, cardiac arrest, hypotension, syncope, and vasodilation.
• Use small IV/large vein; flush prior to and after. AVOID Extravasation (will cause tissue necrosis)
˚ In general, IV Calcium Gluconate is preferred over IV Calcium Chloride in nonemergency settings
due to the potential for extravasation with Calcium Chloride.
• Do not infuse Calcium Chloride in the same IV line as phosphatecontaining solutions.
• Precipitates with NaHCO in IV Bag/Tubing
3
• Pregnancy: Safe
• Lactation: Safe
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Cardiac Arrest or Cardiotoxicity in the Presence of Cardiac Arrest or Cardiotoxicity
Hyperkalemia, Hypocalcemia, or Hypermagnesemia in the Presence of Hyperkalemia,
• IV/IO (SLOW) Hypocalcemia, Hypermagnesemia,
˚ 500–1000mg over 2–5min Calcium Channel Blocker Toxicity
Beta-Blocker Overdose, Refractory to Glucagon and • IV/IO (SLOW)
High-Dose Vasopressors (Off-Label use) ˚ 20mg/kg (0.2mL/kg of the 10%
• IV/IO solution) prn to achieve the desired
˚ 20–40mg/kg over 5–10min followed by an infusion of clinical effect
20–40mg/kg/hr titrated to an adequate hemodynamic
response Note: Calcium Chloride is ×3 more
potent than Calcium Gluconate; use
Calcium Channel Blocker Toxicity (Off-Label use) lower doses of Calcium Chloride to reach
(CaCl preferred over Calcium Gluconate) similar therapeutic doses
• IV/IO
˚ Initial: 1–2g or 20–40mg/kg/hr
Damage Control Resuscitation
• IV/IO (SLOW)
˚ 1000mg after 1st blood unit and after q4th unit.
May be given before TXA
98 • MEDICATIONS