From the Guidelines
Calcium gluconate or calcium chloride should be administered as a first-line treatment for severe hyperkalemia, particularly when ECG changes are present, to stabilize cardiac cell membranes and protect against life-threatening arrhythmias. According to the most recent and highest quality study, 1, calcium chloride or gluconate (IV) is recommended for cardiac membrane stabilization in the treatment of acute or chronic hyperkalemia. The effects of calcium begin within minutes but last only 30-60 minutes, so repeated doses may be necessary while implementing other potassium-lowering strategies.
Key Considerations
- For calcium gluconate, administer 10 mL of a 10% solution (1 gram) intravenously over 2-3 minutes, while calcium chloride is given as 5-10 mL of a 10% solution, as suggested by 1.
- Calcium does not actually lower serum potassium levels but rather stabilizes cardiac cell membranes, protecting against the arrhythmogenic effects of hyperkalemia.
- This membrane stabilization antagonizes the effects of potassium on cardiac conduction, reducing the risk of life-threatening arrhythmias.
- Calcium should be administered through a large vein or central line to avoid tissue damage from extravasation, particularly with calcium chloride which is more irritating to veins.
- In patients taking digoxin, calcium should be administered cautiously as rapid administration may potentiate digoxin toxicity.
Additional Treatment Strategies
- Other interventions that actually remove potassium from the body, such as insulin with glucose, beta-agonists, diuretics, or dialysis in severe cases, should be implemented following calcium administration.
- The treatment of hyperkalemia should be tailored to the individual patient's needs, taking into account the underlying cause of the hyperkalemia and the presence of any comorbid conditions, as discussed in 1.
From the FDA Drug Label
Medical literature also refers to the administration of calcium chloride in the treatment of magnesium intoxication due to overdosage of magnesium sulfate, and to combat the deleterious effects of hyperkalemia as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid. The use of calcium chloride in the setting of hyperkalemia is to combat its deleterious effects as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid 2.
- Key points:
- Calcium chloride is used to counteract the effects of hyperkalemia.
- It is used pending correction of the increased potassium level.
- The effects of hyperkalemia are measured by electrocardiogram (ECG).
From the Research
Calcium in Hyperkalemia
- Calcium plays a crucial role in the management of hyperkalemia, particularly in stabilizing cardiac membranes 3, 4, 5.
- The administration of intravenous calcium salts, such as calcium gluconate, is recommended to stabilize the resting cardiac membrane potential in life-threatening hyperkalemia 4, 5.
- Calcium gluconate 10% dosed 10 mL intravenously is typically provided for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 4.
- The use of calcium in hyperkalemia is aimed at reducing the risk of cardiac dysrhythmias and cardiac arrest, which are potential complications of elevated serum potassium levels 3, 4, 5.
Treatment of Hyperkalemia
- The treatment of hyperkalemia involves a multi-step approach, including measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 3, 4, 5.
- In addition to calcium, other treatments for hyperkalemia include glucose and insulin, bicarbonate, beta-2 agonists, hyperventilation, and dialysis 3, 4.
- New medications, such as patiromer and sodium zirconium cyclosilicate, have also been developed to promote gastrointestinal potassium excretion and hold promise in the management of hyperkalemia 3, 4.