What is the recommended dose of calcium chloride (CaCl2) for intravenous administration?

Calcium Chloride Dosing Recommendations

For adults, administer 2 grams (20 mL of 10% solution) of calcium chloride intravenously at a rate not exceeding 1 mL/min; for pediatric patients, use 20 mg/kg (0.2 mL/kg of 10% solution), with specific dosing adjustments based on the clinical indication. 1

Adult Dosing

Standard dose for hypocalcemia and emergency indications:

• 2 grams (20 mL of 10% calcium chloride solution) administered slowly IV, not exceeding 1 mL/min 2, 1
• This delivers 540 mg of elemental calcium (27 mEq) 2
• For hypocalcemic disorders, the usual range is 200 mg to 1 gram (2-10 mL) at intervals of 1-3 days depending on patient response 1
• Repeated injections may be required every 4-6 hours due to rapid excretion 2, 1

For calcium channel blocker toxicity:

• Initial dose: 2 grams (20 mg/kg) for rapid increase in ionized calcium 2
• Maintain ionized calcium at 1.5-2 times upper limits of normal 2

Pediatric Dosing

Standard pediatric dose:

• 20 mg/kg (0.2 mL/kg of 10% solution) for most indications 1
• Alternative dosing: 2.7 to 5.0 mg/kg hydrated calcium chloride (0.136 to 0.252 mEq elemental calcium per kg) 1
• Repeat dosing every 4-6 hours as needed based on clinical response 1

For specific pediatric emergencies:

• Hypocalcemia, hyperkalemia, hypermagnesemia, or calcium channel blocker toxicity: Consider using calcium gluconate at 60 mg/kg instead, as it causes less tissue irritation if peripheral access is used 3, 4

Administration Guidelines

Route and rate:

• Administer only by slow IV injection, not exceeding 1 mL/min 1
• Preferably use a central or deep vein 1
• If time permits, warm solution to body temperature 1
• Patient should remain recumbent for a short time following injection 1

Critical monitoring during administration:

• Stop infusion immediately if symptomatic bradycardia occurs or heart rate decreases by 10 beats per minute 4
• Continuous ECG monitoring is essential, especially in patients receiving cardiac glycosides 4
• Monitor ionized calcium levels to guide dosing adjustments 1
• Target ionized calcium levels above 0.9 mmol/L (normal range 1.1-1.3 mmol/L) 2

Important Clinical Caveats

Calcium chloride vs. calcium gluconate:

• In cardiac arrest situations, calcium chloride is preferred over calcium gluconate due to more rapid increase in ionized calcium concentration 3
• For peripheral IV administration, calcium gluconate is preferred to minimize vein irritation and tissue injury risk 4

Special considerations:

• Citrate load from blood products during massive transfusion chelates calcium and reduces net increase, potentially requiring higher or more frequent doses 2
• Liver dysfunction impairs citrate metabolism and may necessitate increased calcium dosing 2
• Acidosis increases ionized calcium (0.1 pH unit decrease raises ionized calcium by ~0.05 mmol/L), while alkalosis decreases it 2

Safety precautions:

• Halt injection if patient complains of discomfort; resume when symptoms disappear 1
• Avoid rapid infusion to prevent cardiac arrhythmias 4
• Do not mix calcium with vasoactive amines 4
• Have resuscitation equipment readily available 1

Dosing Clarification

Understanding concentration: 10% calcium chloride contains 100 mg/mL, which represents 27 mg or 1.4 mEq of elemental calcium per mL 1. One 10 mL syringe provides 270 mg of elemental calcium 1. This distinction is critical as dosage recommendations in various references may be given as either amount of calcium chloride or amount of elemental calcium 1, 5.