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

Calcium Chloride Dosing for Intravenous Administration

For adults, administer 2000 mg (20 mL of 10% solution, equivalent to 28 mEq Ca²⁺) of calcium chloride intravenously, and for pediatric patients, administer 20 mg/kg (0.2 mL/kg of 10% solution, equivalent to 0.28 mEq Ca²⁺/kg), with administration rate not exceeding 1 mL/min and preferably through a central venous line. 1

Standard Dosing by Patient Population

Adult Dosing

• Initial bolus: 2000 mg (20 mL of 10% calcium chloride solution = 28 mEq Ca²⁺) administered intravenously 1
• FDA-approved range for hypocalcemia: 200-1000 mg (2-10 mL) at intervals of 1-3 days, depending on patient response and serum ionized calcium levels 2
• Administration rate: Not to exceed 1 mL/min, preferably through a central or deep vein 2

Pediatric Dosing

• Initial bolus: 20 mg/kg (0.2 mL/kg of 10% solution = 0.28 mEq Ca²⁺/kg) 1
• FDA-approved range for hypocalcemia: 2.7-5.0 mg/kg hydrated calcium chloride (0.027-0.05 mL/kg of 10% solution) 2
• Central line strongly preferred: Extravasation through peripheral IV can cause severe skin and soft tissue injury, especially in children 1

Specific Clinical Indications

Calcium Channel Blocker (CCB) Toxicity

• Adult dose: 2000 mg initial bolus, followed by maintenance infusion of 20-40 mg·kg⁻¹·h⁻¹ (0.28-0.56 mEq·kg⁻¹·h⁻¹) 1
• Pediatric dose: 20 mg/kg bolus, followed by same weight-based maintenance infusion 1
• Target: Titrate to blood pressure response, maintaining ionized calcium at 1.5-2 times upper limit of normal 1

Cardiac Arrest/Resuscitation

• The 2023 American Heart Association guidelines provide calcium chloride as the preferred calcium salt during cardiac arrest due to more rapid increase in ionized calcium concentration compared to calcium gluconate 3
• Administer by slow push during cardiac arrest with careful heart rate monitoring 3

Hyperkalemia

• Rapid administration of 10 mL of 10% calcium chloride to protect the myocardium is emphasized in resuscitation guidelines 4
• Note: One 10 mL syringe of 10% calcium chloride provides 270 mg of elemental calcium (27 mg or 1.4 mEq per mL) 2

Critical Administration Guidelines

Route and Rate

• Always administer slowly: Maximum rate of 1 mL/min to prevent cardiac arrhythmias and symptomatic bradycardia 2
• Preferred route: Central or deep vein administration 2
• Halt injection immediately if patient complains of discomfort; may resume when symptoms disappear 2
• Patient should remain recumbent for a short time following injection 2

Monitoring Requirements

• Continuous ECG monitoring is essential during administration 5, 3
• Stop infusion immediately if symptomatic bradycardia occurs or heart rate decreases by 10 beats per minute 5
• Monitor ionized calcium levels during infusion to avoid severe hypercalcemia (>2 times upper limit of normal) 1, 3

Maintenance Infusion Dosing

When continuous infusion is indicated (e.g., CCB toxicity):

• Adult: 20-40 mg·kg⁻¹·h⁻¹ 1
• Pediatric: 0.2-0.4 mL·kg⁻¹·h⁻¹ of 10% solution (equivalent to 20-40 mg·kg⁻¹·h⁻¹) 1
• Titrate to hemodynamic response and ionized calcium levels 1

Important Safety Considerations

Calcium Chloride vs. Calcium Gluconate

• Calcium chloride provides 3 times more elemental calcium per gram than calcium gluconate (270 mg vs 90 mg per gram) 2
• Equivalent elemental calcium doses (approximately 3:1 ratio of gluconate to chloride) produce equivalent ionization and cardiovascular effects 6
• Calcium chloride is preferred during cardiac arrest due to faster ionization 3
• Calcium gluconate is preferred for peripheral administration when central access is unavailable, due to less tissue irritation 5, 3

Common Pitfalls to Avoid

• Do not confuse dosing units: References may cite dose as calcium chloride salt vs. elemental calcium vs. mEq—always clarify which is being used 2, 4
• Avoid rapid infusion: Can cause cardiac arrhythmias, hypotension, and bradycardia 5, 2
• Do not mix with vasoactive amines in the same IV line 5
• Warm solution to body temperature if time permits 2
• Repeated injections may be required due to rapid excretion of calcium; changes in ionized calcium are short-lived (minutes) 2, 6

Special Populations

• Patients on cardiac glycosides: Enhanced monitoring required due to increased risk of arrhythmias 5
• Pediatric patients: Central venous access strongly preferred over peripheral IV 1, 3