Dilution of Calcium Chloride 10% Before Administration
No, you should not dilute 5ml of calcium chloride 10% with 10ml of distilled water before administering it to a patient—calcium chloride 10% should be administered undiluted or diluted only in specific compatible IV fluids (5% dextrose or normal saline), never in distilled water alone. 1, 2
Critical Safety Issues with Your Proposed Dilution
Using distilled water as a diluent is inappropriate and potentially dangerous:
- Distilled water is not an isotonic solution and should never be used as a diluent for intravenous medications 2
- The FDA-approved preparation specifies that calcium chloride 10% may be diluted with water for injection to make a 5% solution for pH adjustment purposes only, not as a standard dilution practice 2
- When dilution is necessary for infusion, calcium chloride should be diluted in 50-100 mL of 5% dextrose or normal saline, not distilled water 3, 1
Proper Administration Guidelines
For bolus administration:
- Administer calcium chloride 10% undiluted at a rate not exceeding 1 mL/min 1
- Standard adult dose is 5-10 mL (500-1000 mg) given IV over 2-5 minutes with continuous ECG monitoring 3
- Pediatric dose is 20 mg/kg (0.2 mL/kg of 10% solution) 1
For infusion administration:
- Dilute in normal saline or 5% dextrose, never distilled water 3, 1
- For maintenance infusion, use 20-40 mg/kg/hour diluted in appropriate IV fluids 1
Route of Administration Considerations
Central venous access is strongly preferred:
- Calcium chloride 10% is hypertonic (2.04 mOsmol/mL) and highly irritating to peripheral veins 4, 2
- Peripheral extravasation may cause severe skin and soft tissue injury 1, 4
- If peripheral administration is unavoidable, use the largest, most secure vein (preferably antecubital), avoid hand/wrist veins, and monitor continuously for infiltration 4
Consider calcium gluconate as an alternative:
- Calcium gluconate is preferred over calcium chloride for peripheral administration due to significantly lower osmolarity and reduced tissue irritation risk 4
- However, calcium chloride is preferred during cardiac arrest due to more rapid increase in ionized calcium concentration 1, 4
Critical Monitoring Requirements
During any calcium chloride administration:
- Continuous ECG monitoring is essential 1
- Stop infusion immediately if symptomatic bradycardia occurs or heart rate decreases by 10 beats per minute 1
- Monitor ionized calcium levels during infusion to avoid severe hypercalcemia (>2 times upper limit of normal) 1
- Enhanced monitoring required in patients on cardiac glycosides due to increased arrhythmia risk 1
Common Pitfalls to Avoid
- Never mix calcium chloride with sodium bicarbonate in the same IV line without adequate barrier fluid separation to prevent calcium carbonate precipitation 1, 4
- Do not mix with vasoactive amines 5
- Avoid rapid administration to prevent hypotension, bradycardia, and cardiac arrhythmias 5
- The solution is oxygen sensitive and should be protected from air exposure 2