II. Mechanism of action: Cardiac effect

  1. Calcium is a positive inotrope
    1. Increases force of myocardial contraction
  2. Variable effect on systemic vascular resistance

III. Efficacy

  1. No proven benefit in Cardiac Arrest

IV. Indications

  1. Hypocalcemia
    1. Often occurs after Blood Transfusion
  2. Hyperkalemia
  3. Hypermagnesemia
  4. Calcium Channel Blocker Overdose or toxicity
    1. May also prevent hypotensive effect of IV agent
  5. Not indicated in:
    1. Asystole
    2. Pulseless Electrical Activity

V. Preparation

  1. Calcium Chloride (10%): 100 mg per ml
    1. Contains 27.2 mg/ml elemental calcium
    2. Advantages over Calcium Gluconate
      1. Higher calcium amount (3x)
      2. Drives predictably higher Serum Calcium levels
        1. Historically preferred in patients with shock
        2. However Calcium Gluconate likely has same efficacy with better peripheral IV safety
      3. Does not require first-pass metabolism
        1. However Calcium Gluconate does not require first-pass metabolism either (despite common dogma)
  2. Calcium Gluconate (10%)
    1. Contains 9 mg/ml elemental calcium
    2. Less venous sclerosis with infusion than with Calcium Chloride
      1. Preferred agent if only peripheral IV available
  3. Calcium Gluceptate
  4. References
    1. Swaminathan and Herbert (2014) EM:Rap 14(1): 13-14
    2. Martin (1990) Anesthesiology 73(1): 62-5 [PubMed]

VI. Dosing: Calcium Gluconate (10%, 0.4 mEq/ml)

  1. Hypocalcemia
    1. Calcium Gluconate 1 gram in 50 ml D5W over 1 hour
  2. Emergent dosing
    1. Initial: 2 ampules (20 ml) IV over 10-30 minutes
    2. Maintenance: 60ml in 500ml D5W at 0.5-2.0 mg/kg/h

VII. Dosing: Calcium Chloride (10%, 1.4 mEq/ml)

  1. Administer no faster than 0.5 to 1 ml/minute
  2. General indications (e.g. Hyperkalemia)
    1. Child: 0.2 - 0.25 ml/kg given very slowly
    2. Adult: 5-10 ml given very slowly
  3. Prophylaxis of Calcium Channel BlockerHypotension
    1. Initial: 2 - 4 mg/kg IV given very slowly (over >10 minutes)
    2. Repeat as needed every 10 minutes

VIII. Precautions

  1. Rapid calcium administration may result in:
    1. Bradycardia
    2. Asystole
  2. Drug Interaction
    1. Digoxin: Digitalis Toxicity
    2. Sodium Bicarbonate: precipitates with calcium
  3. Coronary vasospasm
  4. Local tissue injury
    1. Peripheral vein sclerosis
    2. Local chemical burns if infiltrates into tissue

IX. Monitoring while on Calcium Infusion

  1. Follow Calcium levels every 4-6 hours

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Cost: Medications

calcium gluconate (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
CALCIUM GLUCONATE 500 MG TAB Generic OTC $0.15 each

Ontology: Calcium Chloride (C0006686)

Definition (NCI) A crystalline, white substance, soluble in water, Calcium Chloride is the chloride salt of calcium, a bivalent metallic element with many crucial biological roles. Calcium is a major constituent of the skeleton but plays many roles as an intracellular and plasma ion as well. In medicine, calcium chloride is also used as a 10% solution in injection, for calcium replenishment. (NCI04)
Definition (MSH) A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning.
Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
MSH D002122
SnomedCT 387377009, 68395000
English Calcium Chloride, Chloride, Calcium, Calcium Chloride Hexahydrate, CALCIUM CHLORIDE, Calcium Chloride [Chemical/Ingredient], calcium chloride, CALCIUM CHLORIDE ANHYDROUS, Calcium Chloride Dihydrate, Calcium chloride, Calcium chloride (product), Calcium chloride (substance), Calcium Chloride Anhydrous
French Chlorure de calcium, CaCl2
Swedish Kalciumklorid
Czech chlorid vápenatý
Finnish Kalsiumkloridi
Russian KAL'TSIIA KHLORID, KAL'TSII KHLORISTYI, КАЛЬЦИЙ ХЛОРИСТЫЙ, КАЛЬЦИЯ ХЛОРИД
Japanese 塩化カルシウム
Italian Cloruro di calcio anidro, Cloruro di calcio
Polish Chlorek wapniowy, Wapnia chlorek
Norwegian Kalsiumklorid, Kalsiumklorid-dihydrat
Spanish cloruro de calcio (producto), cloruro de calcio (sustancia), cloruro de calcio, Cloruro de Calcio
German Calciumchlorid, Kalziumchlorid
Portuguese Cloreto de Cálcio

Ontology: Calcium Gluconate (C0006699)

Definition (NCI_NCI-GLOSS) The mineral calcium, combined with a form of the sugar glucose. It is used to prevent and treat bone loss. It is also being studied in the treatment of bone loss and nerve damage caused by chemotherapy.
Definition (NCI) The gluconate salt of calcium. An element or mineral necessary for normal nerve, muscle, and cardiac function, calcium as the gluconate salt helps to maintain calcium balance and prevent bone loss when taken orally. This agent may also be chemopreventive for colon and other cancers. (NCI04)
Definition (MSH) The calcium salt of gluconic acid. The compound has a variety of uses, including its use as a calcium replenisher in hypocalcemic states.
Definition (PDQ) The gluconate salt of calcium. An element or mineral necessary for normal nerve, muscle, and cardiac function, calcium as the gluconate salt helps to maintain calcium balance and prevent bone loss when taken orally. This agent may also be chemopreventive for colon and other cancers. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39172&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39172&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C336" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002125
SnomedCT 387292008, 53691001
English Calcium Gluconate, Gluconate, Calcium, D-Gluconic acid, calcium salt (2:1), Calcium D-gluconate, calcium gluconate (medication), mineral supplements calcium gluconate, Calcium Gluconate [Chemical/Ingredient], calcium gluconate, CALCIUM GLUCONATE, Calcium gluconate, Calcium gluconate (product), Calcium gluconate (substance), CALGLUC
Swedish Kalciumglukonat
Czech glukonát vápenatý
Finnish Kalsiumglukonaatti
Russian KAL'TSIIA GLIUKONAT, КАЛЬЦИЯ ГЛЮКОНАТ
Japanese グルコン酸カルシウム
French Gluconate de calcium, Dextronate de calcium, Maltonate de calcium
Polish Glukonian wapniowy
Spanish gluconato de calcio (producto), gluconato de calcio (sustancia), gluconato de calcio, Gluconato de Calcio
German Calciumgluconat, Kalziumglukonat
Italian Gluconato di calcio
Portuguese Gluconato de Cálcio

Ontology: Calcium gluceptate (C0108111)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C007852
SnomedCT 71714008
English calcium gluceptate, calcium gluceptate (discontinued) (medication), mineral supplements calcium gluceptate (discontinued), calcium gluceptate (discontinued), Calcium Glucoheptonate (1:2), CALCIUM GLUCEPTATE, Calcium Bis((2-xi)-D-gluco-heptonate), Calcium gluceptate, Calcium glucoheptonate, Calcium gluceptate (substance), calcium glucoheptonate, Calcium Gluceptate
Spanish gluceptato de calcio (sustancia), gluceptato de calcio, glucoheptonato de calcio