DRUG SUPPLIED DOSE COMMENTS
CALCIUM CHLORIDE (Paeds)


Mechanism of action:

Calcium replacement



Ref: 37, 44



Last update: 2021-11-13		 injection: 100 mg/mL, 10%, vial 10 mL

PFS: 100 mg/mL, 10%, 10 mL

10% solution contains:
0.68 mmol Ca++ /mL
   
27 mg elemental Ca++ /mL		 Hypocalcemia, Hyperkalemia, Hypermagnesemia or Calcium Channel Blocker Overdose:
0.2 mL/kg/dose IV/IO (5.4 mg elemental Ca/kg/dose [20 mg Ca chloride/kg/dose])
For cardiac arrest:  over 10-20 sec.
For perfusing patients: over 5-10 min.

Repeat dose only for documented calcium deficiency.  For calcium channel blocker overdose, if patient is responsive, may repeat dose or follow initial dose with 5.4-13.5 elemental Ca/kg/hr (20-50  mg Ca chloride/kg/hr) infusion, even if not calcium deficient
Maximum: 270 mg elemental Ca/dose (1 g Ca chloride/dose) = 10 mL of 10% solution.

Continuous IV infusion in critical care areas:20-60 mg elemental Ca/kg/24 hr

(74 - 221 mg/kg/24 hr Ca chloride)
1 gram calcium chloride salt = 270 mg elemental calcium (Ca) = 6.8 mmol elemental Ca.

No benefit has been demonstrated for the use of calcium chloride in cardiac arrest.

Contraindicated in patients with digoxin toxicity.

Preferred to gluconate to correct emergent hypocalcemia.

Gluconate preferred in non-emergent situations because of risk of extravasation
Flush line following administration.

Extravasation can cause severe tissue injury: Refer to ePOPS for Prevention and Management of Infiltration and Extravasation.

Incompatible with ceftriaxone, TPN, sodium bicarbonate, phosphate, dobutamine, magnesium sulfate,  and, propofol, lipids.


Standard Prescription:

calcium chloride    mg elemental calcium IV (    mg/kg/dose)
or
calcium chloride ___ mmol/kg/day elemental calcium IV infusion