Page 123 - 2023 SMOG Digital

CALCIUM Chloride 10% Safe, Lactation Safe
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 (eg, tetany,
seizures, arrhythmias); emergent treatment of severe hypermagnesemia; massive transfusion prophylaxis
Unlabeled: Calcium channel blocker overdose; beta-blocker overdose (refractory to glucagon and high-
dose vasopressors); severe hyperkalemia (K+ >6.5mEq/L with toxic ECG changes) [ALS guidelines];
malignant arrhythmias (including cardiac arrest) associated with hypermagnesemia [ALS guidelines]
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
life-threatening arrhythmias
• Rapid push can cause: Arrhythmia, bradycardia, cardiac arrest, hypotension, syncope, vasodilation
• Use small IV / Large Vein, flush prior and after, AVOID Extravasation (will cause tissue necrosis)
o 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 I.V. line as phosphate-containing solutions.
• Precipitates with NaHCO3 in IV Bag/Tubing
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Cardiac arrest or cardiotoxicity in the presence Cardiac arrest or cardiotoxicity in the presence
of hyperkalemia, hypocalcemia, or of hyperkalemia, hypocalcemia, or
hypermagnesemia: IV/IO, SLOW hypermagnesemia:
• 500-1000 mg over 2-5 minutes IV/IO, SLOW
Beta-blocker overdose, refractory to glucagon • 20mg/kg (maximum: 2000mg/dose); may
and high-dose vasopressors (unlabeled use): repeat as necessary
IV/IO
• 20mg/kg over 5-10 minutes followed by an Calcium channel blocker overdose (unlabeled
use):
infusion of 20mg/kg/hour titrated to adequate IV/IO
hemodynamic response
Calcium channel blocker overdose (unlabeled • Initial: 20mg/kg (0.2ml/kg) (maximum:1000
mg/dose) over 10-15 minutes; may repeat
use) (CaCl preferred over Calcium Gluconate for q10-15 min
this use): IV/IO
• Initial: 1000mg over 5 minutes; may repeat Note: Adult and Pediatric dosages are expressed
in terms of the calcium chloride salt based on a
q10-20min with 3-4 additional doses; or a solution concentration of 100mg/mL (10%)
continuous infusion of 2-6grams/hour may be containing 1.4mEq (27mg/mL) elemental calcium.
initiated (1gram = 10cc of a 10% solution)
Hypocalcemia prophylaxis from massive
transfusion Note: Calcium Chloride is 3X more potent than
Calcium Gluconate and therefore lower doses of
• 10ml (10cc) 10% solution over 5 minutes Calcium Chloride must be used to reach similar
Damage Control Resuscitation: IV/IO, SLOW therapeutic doses
1000mg after 1 st blood unit and after every 4 th unit
123