Calcium chloride Side Effects
Applies to calcium chloride: compounding powder, injectable solution
Nervous system
Nervous system side effects, upon rapid injection, have included tingling sensations, a calcium taste, or a sense of oppression or "heat wave."[Ref]
Local
Local side effects have included phlebitis, a "burning" sensation and calcinosis cutis at the site of intravenous administration. Calcification of veins has been rarely reported.[Ref]
A slow infusion rate through a small bore needle into a large vein may minimize this venous irritation.[Ref]
Cardiovascular
During ischemia, myocardial cells lose their ability to pump intracellular calcium back into the sarcoplasmic reticulum and out of the cell during diastole. Sustained increases in the intracellular calcium concentration lead to pathological intracellular changes that may result in reduced myocardial systolic and diastolic function.
Calcium may reduce myocardial oxygen supply by causing coronary artery vasoconstriction or spasm or by increasing ventricular contractility and work.
The American Heart Association no longer recommends the routine use of calcium chloride during cardiopulmonary resuscitation.
While many of the cardiovascular effects of injection can be expected, some may be anticipated and prevented. Injections can be accompanied by peripheral vasodilatation as well as a local "burning" sensation. Injections that are too rapid may produce hypotension and/or syncope. Rare complications following infusion include the development of vasospastic angina, serious cardiac arrhythmias, AV dissociation, or shock. Some of these side effects have occurred in patients who were digitalized. Extreme caution is advised when administering to a patient who has received digitalis since calcium may unmask digitalis intoxication.[Ref]
Cardiovascular side effects have included peripheral vasodilation, hypotension, and syncope. Vasospastic angina, serious cardiac arrhythmias, AV dissociation, and shock have been reported rarely. Administration to digitalized patients may unmask digitalis intoxication.[Ref]
References
1. "Product Information. Calcium chloride 10% (calcium chloride)." Astra USA, Westborough, MA.
2. Edelson GW, Kleerekoper M "Hypercalcemic crisis." Med Clin North Am 79 (1995): 79-92
3. Speer ME, Rudolph AJ "Calcification of superficial scalp veins secondary to intravenous infusion of sodium bicarbonate and calcium chloride." Cutis 32 (1983): 65-6
4. Miura T, Akiba H, Saito N, Seiji M, Tanaka S, Okada Y "Calcinosis cutis developing after phlebitis." Dermatologica 146 (1973): 292-6
5. Goldminz D, Barnhill R, McGuire J, Stenn KS "Calcinosis cutis following extravasation of calcium chloride." Arch Dermatol 124 (1988): 922-5
6. Thompson BM, Steuven HS, Tonsfeldt DJ, Aprahamian C, Troiano PF, Kastenson GH, Hendley GE, Mateer JR, Tucker JF "Calcium: limited indications, some danger." Circulation 74 (1986): iv90-3
7. Boulanger M, Maille JG, Pelletier GB, Michalk S "Vasospastic angina after calcium injection." Anesth Analg 63 (1984): 1124-6
8. Harrison EE, Amey BD "The use of calcium in cardiac resuscitation." Am J Emerg Med 1 (1983): 267-73
9. Auerbach PS, Langenberg A "Ventricular fibrillation associated with calcium administration during cardiopulmonary resuscitation." J Emerg Nurs 11 (1985): 69-71
10. Chin RL, Garmel GM, Harter PM "Development of ventricular fibrillation after intravenous calcium chloride administration in a patient with supraventricular tachycardia." Ann Emerg Med 25 (1995): 416-9
11. Katz AM "Is calcium beneficial or deleterious in patients with cardiac arrest?" Ann Intern Med 109 (1988): 91-2
12. Royster RL, Butterworth JF 4th, Prielipp RC, Robertie PG, Kon ND, Tucker WY, Dudas LM, Zaloga GP "A randomized, blinded, placebo-controlled evaluation of calcium chloride and epinephrine for inotropic support after emergence from cardiopulmonary bypass." Anesth Analg 74 (1992): 3-13
13. Carlon GC, Howland WS, Goldiner PL, Kahn RC, Bertoni G, Turnbull AD "Adverse effects of calcium administration. Report of two cases." Arch Surg 113 (1978): 882-5
14. Stempien A, Katz AM, Messineo FC "Calcium and cardiac arrest." Ann Intern Med 105 (1986): 603-6
Not all side effects for calcium chloride may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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