What is the recommended dose of calcium chloride for treating hyperkalemia?

Calcium Chloride Dose for Hyperkalemia

For hyperkalemia with cardiac arrest or life-threatening ECG changes, administer calcium chloride 10% at 5-10 mL (500-1000 mg) IV push over 2-5 minutes. 1, 2

Calcium Chloride vs Calcium Gluconate

Calcium chloride is the preferred calcium salt during cardiac arrest because it provides three times more elemental calcium and achieves more rapid increases in ionized calcium concentration compared to calcium gluconate. 2, 3

• Calcium chloride 10%: 5-10 mL IV over 2-5 minutes (preferred in cardiac arrest and critical situations) 1, 2
• Calcium gluconate 10%: 15-30 mL IV over 2-5 minutes (alternative, preferred for peripheral IV access) 1, 4, 2

The American Heart Association specifically recommends calcium chloride for cardiac arrest scenarios, while calcium gluconate is safer for peripheral IV administration due to lower risk of tissue necrosis if extravasation occurs. 1, 4, 2

Administration Protocol

Initial Dose and Monitoring

• Administer the initial dose over 2-5 minutes with continuous ECG monitoring 1, 2
• Onset of action occurs within 1-3 minutes 4, 2
• Effects are temporary, lasting only 30-60 minutes 4, 2

Repeat Dosing

• Monitor ECG response for 5-10 minutes after the initial dose 4
• A second dose may be administered if no clinical or ECG improvement is observed within 5-10 minutes 4
• Stop injection immediately if symptomatic bradycardia develops 4, 2

Critical Administration Considerations

Route of Administration

• Calcium chloride should be administered through a central venous catheter when possible because extravasation through peripheral IV can cause severe skin and soft tissue injury 2
• If only peripheral access is available, calcium gluconate is the safer alternative 4

Drug Compatibility

• Never administer calcium through the same IV line as sodium bicarbonate - this causes precipitation 4
• In patients with elevated phosphate levels, calcium administration may increase risk of calcium-phosphate precipitation in tissues 4

Mechanism and Limitations

Calcium administration does NOT lower serum potassium levels - it only stabilizes cardiac membranes by counteracting the effects of hyperkalemia on myocardial conduction. 4, 2, 3

This is purely a temporizing measure that must be followed immediately by:

1. Potassium-shifting therapies (insulin/glucose, beta-2 agonists) to move potassium intracellularly 2, 5
2. Potassium elimination strategies (diuretics, dialysis, potassium binders) for definitive management 2, 5

Pediatric Dosing

For pediatric patients with hyperkalemia:

• Calcium chloride: 20 mg/kg (0.2 mL/kg of 10% solution) via slow infusion with ECG monitoring 2
• Calcium gluconate: 100-200 mg/kg/dose via slow infusion with ECG monitoring 4

Common Pitfalls to Avoid

• Do not delay calcium administration while waiting for confirmatory potassium levels if ECG changes consistent with hyperkalemia are present - absent or atypical ECG changes do not exclude the need for immediate intervention 5
• Do not rely solely on calcium - concurrent therapies must be initiated simultaneously as calcium's protective effect is brief 4, 3
• Do not use the same IV line for calcium and bicarbonate administration 4
• Be aware that calcium chloride preparations vary by country and manufacturer - verify the actual calcium content of your institution's formulation 6