Usage
Calcium Chloride is prescribed for the treatment of hypocalcemia, a condition characterized by low blood calcium levels. It is also used in emergency situations like cardiac resuscitation, hyperkalemia, hypermagnesemia, calcium channel blocker overdose, and beta-blocker overdose. It falls under the pharmacological classifications of mineral supplement, electrolyte replenisher, and antidote. Calcium chloride works by directly increasing the concentration of calcium ions in the blood. Calcium plays a crucial role in numerous physiological processes, including nerve impulse transmission, muscle contraction, blood coagulation, and bone formation.
Alternate Names
Calcium Chloride is also known as CaCl or CaCl2. Some brand names under which it’s marketed include: Calcium Chloride Injection USP, and generics.
How It Works
Pharmacodynamics: Calcium is essential for various physiological functions, including nerve conduction, muscle contraction, myocardial function, and blood clotting. Calcium chloride acts by directly increasing the extracellular calcium concentration.
Pharmacokinetics:
- Absorption: When administered intravenously, calcium chloride is immediately available. Oral absorption of calcium varies depending on factors like vitamin D levels, dietary factors, and gastrointestinal conditions.
- Distribution: Calcium is distributed throughout the body, primarily in bones and teeth. Extracellular calcium exists in ionized, protein-bound, and complexed forms.
- Metabolism: Calcium itself is not metabolized. However, its homeostasis is regulated by hormones such as parathyroid hormone, calcitonin, and vitamin D.
- Elimination: Primarily excreted renally, with some fecal excretion.
Dosage
Standard Dosage
Adults:
500-1000 mg intravenously (IV) over 5-10 minutes; may repeat as necessary. The maximum dose may vary depending on the indication. Slow intravenous infusion is crucial to avoid complications.
Children:
Dosing based on weight is recommended. In infants, less than 75 mg (20 mg elemental Ca) IV; may be repeated if needed. Children: 75-519 mg (20-140 mg elemental Ca) IV may be repeated. Neonates 171 mg/kg/day IV divided into doses. Close monitoring of calcium levels is important.
Special Cases:
- Elderly Patients: Dose adjustments might be needed based on organ function and electrolyte status. Start with the lower end of the adult dosage range and titrate as per response.
- Patients with Renal Impairment: Reduce the dose and closely monitor serum calcium levels. Consider the patient’s glomerular filtration rate and electrolyte balance. 200 mg starting dose recommended.
- Patients with Hepatic Dysfunction: Cautious use is advised, although specific dose adjustments are not usually necessary. Monitor serum calcium closely.
- Patients with Comorbid Conditions: Adjust based on the patient’s coexisting medical conditions and concurrent medications.
Clinical Use Cases
- Intubation: Administer as needed for hypocalcemia during intubation.
- Surgical Procedures: Dosage should be tailored to maintain calcium levels during surgery.
- Mechanical Ventilation: Administer as needed for hypocalcemia during mechanical ventilation.
- Intensive Care Unit (ICU) Use: Continuous infusion may be required with careful monitoring of serum calcium.
- Emergency Situations: Cardiac arrest: 1 g IV push (not routinely recommended); Hyperkalemia with ECG changes: 1 g IV; Calcium channel blocker overdose: 1-2 g IV over 10-20 minutes. Beta-blocker overdose: 1 g IV bolus.
Side Effects
Common Side Effects
- Flushing, warmth, or tingling sensation
- Nausea
- Bradycardia
- Hypotension (with rapid administration)
- Metallic taste in the mouth
Rare but Serious Side Effects
- Cardiac arrest (with rapid IV administration)
- Arrhythmias
- Peripheral vasodilation
- Severe hypotension
- Tissue necrosis at injection site (with extravasation)
Adverse Drug Reactions (ADR)
- Severe hypersensitivity reactions
- Syncope
Contraindications
- Hypercalcemia
- Ventricular fibrillation (during CPR)
- Digitalis toxicity risk
- Renal calculi
- Hypersensitivity to calcium chloride
- Intramuscular (IM) or subcutaneous (SC) administration
Drug Interactions
Calcium chloride can interact with several medications, including:
- Digoxin: Increased risk of digoxin toxicity
- Calcium channel blockers: Reduced efficacy of calcium channel blockers
- Ceftriaxone: Formation of precipitates (should not be co-administered)
- Tetracycline antibiotics: Reduced absorption of tetracyclines
- Thiazide diuretics: May increase serum calcium levels
- Biphosphonates: Reduced absorption of biphosphonates
Pregnancy and Breastfeeding
- Pregnancy: Use with caution if benefits outweigh risks. Data regarding safety in pregnancy is limited. Calcium crosses the placenta and enters breastmilk.
- Breastfeeding: Use cautiously. Calcium is present in human milk. Monitor infants for hypercalcemia symptoms.
Drug Profile Summary
- Mechanism of Action: Directly increases serum calcium levels.
- Side Effects: Flushing, warmth, tingling, nausea, bradycardia, hypotension, metallic taste. Serious side effects include cardiac arrest, arrhythmias, tissue necrosis.
- Contraindications: Hypercalcemia, ventricular fibrillation during CPR, digitalis toxicity risk, renal calculi, hypersensitivity to calcium chloride.
- Drug Interactions: Digoxin, calcium channel blockers, ceftriaxone, tetracycline antibiotics, thiazide diuretics.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Adults: 500-1000 mg IV over 5-10 minutes. Children: Dose by weight.
- Monitoring Parameters: Serum calcium, ECG, blood pressure, heart rate.
Popular Combinations
Calcium chloride is often used in combination with other medications in specific clinical situations, such as epinephrine during cardiac resuscitation or insulin and glucose for hyperkalemia treatment.
Precautions
- Administer via slow intravenous infusion.
- Monitor serum calcium levels regularly.
- Avoid extravasation; ensure proper IV access.
- ECG monitoring is crucial, especially with rapid administration.
- Renal and hepatic function should be assessed prior to administration.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Chloride?
A: Adults: 500-1000 mg IV over 5-10 minutes. Children: Dose by weight. Consult pediatric dosing guidelines.
Q2: What are the common side effects of calcium chloride?
A: Flushing, metallic taste, nausea, slow heart rate, and low blood pressure are some potential side effects.
Q3: What are the contraindications for calcium chloride use?
A: Hypercalcemia, ventricular fibrillation during CPR, and digitalis toxicity are major contraindications.
Q4: Can Calcium Chloride be administered intramuscularly?
A: No, IM or SC administration is contraindicated due to the risk of tissue necrosis.
Q5: How does Calcium Chloride work in hyperkalemia?
A: It antagonizes the cardiac effects of hyperkalemia by stabilizing the cardiac cell membrane.
Q6: What precautions should be taken during Calcium Chloride administration?
A: Slow IV infusion, serum calcium monitoring, and ECG monitoring are essential precautions.
Q7: Is Calcium Chloride safe to use during pregnancy?
A: Limited data available. Use with caution if benefits outweigh risks. Discuss with a healthcare professional.
Q8: How should Calcium Chloride be administered in cardiac arrest?
A: 1 g IV push (not routinely recommended; use only if specific indications are present).
Q9: How does calcium chloride interact with digoxin?
A: It can increase the risk of digoxin toxicity; therefore, monitor closely and adjust the digoxin dose as needed.
Q10: Can calcium chloride be used in hypermagnesemia?
A: Yes, it can be used to counteract the effects of hypermagnesemia, particularly respiratory depression.
