From the Guidelines
Calcium chloride is a crucial medication for treating hypocalcemia, and its administration should be guided by the most recent evidence, with a typical dose of 500-1000 mg (5-10 mL of 10% solution) for adults and 20 mg/kg for pediatric patients, as recommended by the highest quality study 1.
Key Considerations
- The dose of calcium chloride should be administered intravenously over 5-10 minutes for emergent situations, with slower administration for non-urgent cases, and it is essential to monitor serum calcium levels, electrocardiogram, blood pressure, and heart rate 1.
- Calcium chloride must be given via a central line whenever possible, as it is extremely irritating to peripheral veins and can cause tissue necrosis if extravasation occurs, and it should never be administered intramuscularly or subcutaneously 1.
- The preferred agent to correct hypocalcemia is calcium chloride, which contains three times more elemental calcium than calcium gluconate, making it more potent but also more irritating to veins 1.
Monitoring and Contraindications
- Important monitoring parameters include serum calcium levels, electrocardiogram (particularly the QT interval), blood pressure, and heart rate 1.
- Calcium chloride is contraindicated in patients with hypercalcemia, ventricular fibrillation, and digitalis toxicity, as it can potentiate digitalis effects 1.
- Common side effects include hypotension, bradycardia, cardiac arrhythmias, and local injection site reactions 1.
Clinical Context
- In the context of trauma patients and massive transfusion, hypocalcemia is a common finding, and low calcium concentrations at admission are associated with platelet activation, aggregation, decreased clot strength, blood transfusions, and increased mortality 1.
- Transfusion-induced hypocalcemia should be corrected promptly, as ionized Ca2+ levels below 0.8 mmol/L are associated with cardiac dysrhythmias, and calcium chloride may be preferable to calcium gluconate in this setting 1.
From the FDA Drug Label
DESCRIPTION 10% Calcium Chloride Injection, USP is a sterile, nonpyrogenic, hypertonic solution. Each mL contains 100 mg (1.4 mEq/mL) of calcium chloride, dihydrate (1. 4 mEq each of Ca++ and Cl-) in water for injection. SPL UNCLASSIFIED 10% Calcium Chloride Injection, USP Rx Only 1 g/10 mL (100 mg/mL) Represents 27 mg (1.4 mEq) Ca++/mL A HYPERTONIC SOLUTION IN A 10 ML SINGLE DOSE SYRINGE FOR PROMPT INTRAVENOUS INJECTION. HOW SUPPLIED 10% CALCIUM CHLORIDE INJECTION, USP is supplied in the following dosage forms. NDC 51662-1379-1 10% CALCIUM CHLORIDE INJECTION, USP 1 g/10 mL (100 mg/ mL) (1.4 mEq/mL) LUER-JET™ SYR
The calcium chloride drug card contains the following key information:
- Drug Name: calcium chloride (IV)
- Concentration: 10% (100 mg/mL) or 1.4 mEq/mL of calcium chloride
- Dosage Form: 10 mL single-dose syringe for prompt intravenous injection
- Administration: administer only by slow injection (not to exceed 1 mL/minute) 22
- Storage: store at 20° to 25°C (68° to 77°F) 2
From the Research
Calcium Chloride Drug Card
- Indication: Calcium chloride is used to treat hypocalcemia (low calcium levels in the blood) in critically ill patients 3.
- Mechanism of Action: Calcium chloride works by increasing the level of calcium in the blood, which is essential for muscle contraction and neurotransmitter release 4.
- Administration: Calcium chloride can be administered intravenously, and the dose may vary depending on the severity of hypocalcemia and the patient's response to treatment 3, 4.
- Effects: Administration of calcium chloride has been shown to increase mean arterial pressure and left ventricular stroke work index in critically ill patients with hypocalcemia 3.
- Side Effects: The use of calcium chloride in critically ill patients may be associated with poor outcomes, and its benefits and risks need to be further explored in randomized controlled trials 5.
- Contraindications: Calcium chloride should be used with caution in patients with hypercalcemia (high calcium levels in the blood) or those with kidney disease, as it may worsen these conditions 6.
- Interactions: Calcium chloride may interact with other medications, such as lithium and thiazide diuretics, which can cause hypercalcemia 6.
- Monitoring: Patients receiving calcium chloride should be closely monitored for changes in calcium levels, kidney function, and cardiac function 4, 5.