Calcium Chloride

Pronunciation: (KAL-see-um KLOR-ide)
Class: Mineral

Trade Names

Calcium chloride
- Injection 10% (1.36 mEq of elemental calcium/mL)

Pharmacology

Essential in the functional integrity of the nervous and muscular systems, where it has a major influence on the excitability of these tissues. Calcium is necessary for normal cardiac function and is involved in blood coagulation. 1 g (10 mL) of calcium chloride 10% contains 273 mg (13.6 mEq) of elemental calcium.

Indications and Usage

Treatment of hypocalcemia, including hypocalcemic tetany; hyperkalemia with ECG changes; magnesium intoxication due to overdosage of magnesium sulfate; cardiac resuscitation when epinephrine has failed to improve weak or ineffective myocardial contractions; adjunctive therapy in various conditions such as insect bites or stings (eg, black widow spider bites); sensitivity reactions (particularly when characterized by urticaria); as an aid in the treatment of depression due to overdosage of magnesium sulfate; as an aid in the management of acute symptoms in lead colic.

Unlabeled Uses

Calcium channel blocker overdose; beta-blocker overdose.

Contraindications

Ventricular fibrillation; hypercalcemia. Not recommended in the treatment of asystole and electromechanical dissociation.

Dosage and Administration

Cardiac Resuscitation
Adults

IV 500 to 1,000 mg (5 to 10 mL), or 200 to 800 mg (2 to 8 mL) injected into the ventricular cavity. Avoid injection into the cardiac muscle. According to the Advanced Cardiac Life Support (ACLS) guidelines, routine use of calcium chloride is no longer recommended during cardiac resuscitation. If given, a dose of 8 to 16 mg/kg (usually 5 to 10 mL) IV should be given and may be repeated as necessary.

Hypocalcemia (Including Hypocalcemic Tetany)
Adults

IV 500 to 1,000 mg (5 to 10 mL) at intervals of 1 to 3 days injected slowly. Repeated injections may be necessary because of rapid excretion of calcium.

Children

IV 2.7 to 5 mg/kg of hydrated calcium chloride (or 0.136 to 0.252 mEq of elemental calcium per kg, or 0.027 to 0.05 mL of calcium chloride 10% injection per kg) every 4 to 6 h.

Hyperkalemia
Adults

IV Titrate dosage by constant monitoring of ECG changes during administration.

Magnesium Overdose
Adults

IV 500 mg (5 mL). Observe the patient for signs of recovery before further doses are given.

Off-label dosing
Beta-blocker Overdose Adults

IV Administer 1,000 to 2,000 mg (10 to 20 mL) IV. Monitor ECG, serum calcium, ionized calcium, and patient status carefully during calcium therapy. The effect may be short-lived and repeat doses may be necessary.

Children

IV Administer 10 to 20 mg/kg (0.1 to 0.2 mL/kg) IV. Monitor ECG, serum calcium, ionized calcium, and patient status carefully during calcium therapy. The effect may be short-lived and repeat doses may be necessary.

Calcium Channel Blockers Overdose Adults

IV Initial dosage is 1,000 to 2,000 mg (10 to 20 mL) IV. Higher doses may be required. In some cases, several grams may be necessary. In severe cases, continuous infusion of calcium chloride may be needed at a rate of 10 to 40 mg/kg/h IV. Monitor ECG and calcium levels.

Children

IV Initial dosage is 10 to 20 mg/kg (0.1 to 0.2 mL/kg) IV. Repeat as necessary. In severe cases, continuous infusion of calcium chloride may be needed at a rate of 20 to 50 mg/kg/h IV. Monitor ECG and calcium and ionized calcium levels.

Cardiac Resuscitation Children

IV 20 mg/kg (0.2 mL/kg) IV every 10 min as needed.

Hyperkalemia Adults

IV 500 mg to 1,000 mg (5 to 10 mL) IV over 2 to 5 min.

Hypermagnesemia Adults

IV 500 mg to 1,000 mg (5 to 10 mL) IV. This dose may be repeated if necessary.

Hypocalcemia Adults

IV 500 mg (5 mL) IV over 10 min, followed by 36.6 mL (1,000 mg of elemental calcium) IV over the next 6 to 12 h. Measure serum calcium every 4 to 6 h.

General Advice

• For IV use. When used for cardiac resuscitation, administer directly into the ventricular cavity. Do not give by IM or subcutaneous route.
• Inject slowly, not to exceed a rate of 1 mL/min.
• Administer preferably in a central or deep vein.
• Care should be taken to avoid extravasation or accidental injection into perivascular tissues.
• Dosage is based on the calcium chloride 10% (100 mg/mL) salt solution. Each 1 mL of calcium chloride 10% injection solution contains 27 mg (1.4 mEq) of elemental calcium.
• Institute oral calcium as soon as practicable.
• Calcium gluconate is generally preferred over calcium chloride because it is less irritating.

Storage/Stability

Store at 59° to 86°F.

Drug Interactions

Cardiac glycosides (eg, digoxin)

May potentiate digitalis toxicity.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Hypotension.

CNS

Sense of oppression.

GI

Calcium taste in mouth.

Miscellaneous

Tingling sensation; sensation of heat waves.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Extravasation risk

May cause severe necrosis and sloughing if injected into muscle or into subcutaneous or perivascular tissue. Should perivascular infiltration occur, IV administration at that site should be discontinued at once. Local infiltration of the affected area with procaine hydrochloride 1%, to which hyaluronidase may be added, will often reduce vasospasm and dilute the calcium remaining in the tissues locally.

Hypercalcemia

Because hypercalcemia may be more dangerous than hypocalcemia, avoid overtreatment of hypocalcemia.

Hypocalcemic tetany

Other therapy such as parathyroid hormone or vitamin D may be indicated according to the etiology of the tetany.

Rapid IV administration

Too rapid IV administration or overdosage may produce serious cardiac effects, including arrhythmia, bradycardia, and ventricular fibrillation.

Overdosage

Symptoms

Serious cardiac effects, including bradycardia, arrhythmia, and ventricular fibrillation; acute hypercalcemia syndrome (eg, coma, intractable nausea and vomiting, lethargy, markedly elevated plasma calcium level, sudden death, weakness).

Patient Information

• Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
• Advise patient, family, or caregiver to immediately report any of the following to health care provider: general body weakness, injection-site reaction or pain, intractable nausea and vomiting.

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