Calcium Chloride for Hypocalcemia Treatment
Calcium chloride is the preferred agent for treating hypocalcemia, especially in critically ill patients, with an adult dosage of 10 mL of 10% solution (containing 270 mg of elemental calcium) administered intravenously for prompt correction of low calcium levels. 1
Indications for Calcium Chloride
- Calcium chloride is indicated for the treatment of hypocalcemia in conditions requiring a prompt increase in plasma calcium levels 2
- Specific indications include:
Physiological Importance of Calcium
- Ionized calcium (normal range: 1.1-1.3 mmol/L) is essential for:
- Formation and stabilization of fibrin polymerization sites 1
- Multiple platelet-related functions 1
- Cardiac contractility and systemic vascular resistance 1
- Acts as a cofactor in the activation of coagulation factors II, VII, IX, X, and proteins C and S 1
- Necessary for platelet adhesion at sites of vessel injury 1
Dosage and Administration
Adult Dosage:
- For hypocalcemic disorders: 200 mg to 1 g (2-10 mL of 10% solution) at intervals of 1-3 days depending on response 2
- For acute correction: 10 mL of 10% calcium chloride solution (contains 270 mg of elemental calcium) 1
- For continuous infusion: Dilute 10% calcium chloride in appropriate IV fluids and titrate to maintain normal calcium levels 2
Pediatric Dosage:
- 20 mg/kg (0.2 mL/kg of 10% CaCl₂) 1
- Alternative calculation: 2.7 to 5.0 mg/kg hydrated calcium chloride (0.027 to 0.05 mL/kg of 10% solution) 2
Administration Guidelines
- Administer by slow intravenous injection, not exceeding 1 mL/min 2
- Preferably infuse into a central or deep vein 2, 3
- For cardiac arrest: Give by slow push 1
- For other indications: Infuse over 30-60 minutes 1
- Monitor heart rate during administration 1
- Halt injection if patient complains of discomfort; resume when symptoms disappear 2
- Patient should remain recumbent for a short time following injection 2
Monitoring
- Monitor ionized calcium levels during treatment, especially during massive transfusion 1
- Maintain ionized calcium levels above 0.9 mmol/L 1
- Promptly correct ionized Ca²⁺ levels below 0.8 mmol/L as they are associated with cardiac dysrhythmias 1
- ECG monitoring is recommended during rapid administration 4
Calcium Chloride vs. Calcium Gluconate
- Calcium chloride is preferred over calcium gluconate for critically ill patients 1
- 10 mL of 10% calcium chloride contains 270 mg of elemental calcium 1
- 10 mL of 10% calcium gluconate contains only 90 mg of elemental calcium 1
- Calcium chloride results in more rapid increase in ionized calcium concentration 1, 4
- Calcium chloride is particularly beneficial in patients with liver dysfunction, where decreased citrate metabolism results in slower release of ionized calcium 1
- Dose equivalence: 10 mL of 10% calcium gluconate (2.2 mmol calcium) is equivalent to 4.4 mL of 7.35% calcium chloride or 2.2 mL of 14.7% calcium chloride 4
Precautions and Adverse Effects
- Administration through a central venous catheter is preferred 1, 3
- Extravasation through a peripheral IV line may cause severe skin and soft tissue injury 1, 3
- Stop injection if symptomatic bradycardia occurs 1
- Do not mix with sodium bicarbonate 1
- High calcium doses may increase mortality in septic patients 5
- Calcium chloride is more irritant to veins than calcium gluconate 4, 6
Special Considerations
- In trauma patients with massive transfusion, hypocalcemia results from citrate-mediated chelation of serum Ca²⁺ 1
- Each unit of packed red blood cells or fresh frozen plasma contains approximately 3g of citrate 1
- Hypocalcemia within the first 24 hours of critical bleeding can predict mortality and need for multiple transfusions 1
- In liver dysfunction, calcium chloride is preferred due to impaired citrate metabolism 1