Recommended Calcium Dosing for Hypocalcemia
For hypocalcemia treatment, calcium chloride should be administered at a dose of 200 mg to 1 g (2-10 mL) intravenously at intervals of 1 to 3 days for adults, with the specific dose depending on the severity of hypocalcemia and patient response. 1
Dosing Guidelines by Route of Administration
Intravenous Calcium Chloride
- Adult dosing: 200 mg to 1 g (2-10 mL) at intervals of 1-3 days 1
- Pediatric dosing: 2.7-5.0 mg/kg (0.027-0.05 mL/kg of 10% solution) 1
- Administration rate: Slow IV injection not exceeding 1 mL/min, preferably in central or deep vein 1
- Contains 27 mg (1.4 mEq) of elemental calcium per mL 1
Intravenous Calcium Gluconate
- Individualize dose based on severity of hypocalcemia 2
- Contains 9.3 mg (0.4665 mEq) of elemental calcium per 100 mg calcium gluconate 2
- Can be administered as bolus or continuous infusion via secure IV line 2
- For mild hypocalcemia: 1-2 g IV calcium gluconate (effective in 79% of cases) 3
- For moderate to severe hypocalcemia: 2-4 g IV calcium gluconate (effective in only 38% of cases) 3
Monitoring Recommendations
- Monitor ionized calcium levels during treatment 1, 2
- For intermittent infusions: Check serum calcium every 4-6 hours 2
- For continuous infusions: Check serum calcium every 1-4 hours 2
- Halt injection if patient complains of discomfort; resume when symptoms disappear 1
Special Considerations
Massive Transfusion
- Monitor ionized calcium levels during massive transfusion 4
- Administer calcium chloride if ionized calcium levels are low or ECG changes suggest hypocalcemia 4
- Maintain ionized calcium concentration above 0.9 mmol/L to support coagulation and cardiovascular function 4
Chronic Kidney Disease
- An individualized approach should be used for hypocalcemia treatment in CKD patients 4
- Correct significant or symptomatic hypocalcemia to prevent adverse consequences 4
- Total elemental calcium intake (dietary + supplements) should not exceed 2,000 mg/day 5
Administration Precautions
- Calcium chloride should be administered by slow push for cardiac arrest 5
- For other indications, infuse over 30-60 minutes with heart rate monitoring 5
- Central venous catheter administration is preferred to avoid tissue injury from extravasation 5
- Calcium gluconate is not physically compatible with fluids containing phosphate or bicarbonate 2
- Patient should remain recumbent for a short time following injection 1
Potential Complications
- Hypercalcemia from overcorrection
- Renal calculi formation
- Tissue necrosis with extravasation of IV calcium
- Calcinosis cutis (rare) 5
Clinical Pearls
- Repeated injections may be required due to rapid calcium excretion 1
- Individual response to calcium therapy is highly variable 3
- For severe hypocalcemia, more aggressive dosing and frequent monitoring are required 3
- Calcium chloride provides more elemental calcium per mL than calcium gluconate and may be preferred in critical situations 5, 1
By following these dosing guidelines and monitoring recommendations, clinicians can effectively manage hypocalcemia while minimizing potential complications.