Dosage guidance:
Dosing: 1,000 mg of calcium chloride = 270 mg of elemental calcium = 14 mEq of elemental calcium.
Safety: Dosing may be presented as calcium chloride or as elemental calcium and expressed as mg/kg or mEq/kg; use caution.
Calcium channel blocker toxicity, treatment: Limited data available: Neonates: Dose expressed as calcium chloride: IV: Bolus dose: 10 to 20 mg/kg/dose infused over 10 to 15 minutes; if ineffective, may repeat bolus dose every 10 to 15 minutes or initiate continuous IV infusion: 20 to 50 mg/kg/hour (Ref).
Cardiac arrest in the presence of hyperkalemia or hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity (PALS recommendations): Note: Calcium chloride is the preferred salt in urgent situations; not recommended in the absence of hyperkalemia, hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity due to the lack of improved survival (Ref).
Neonates: Dose expressed as calcium chloride: IV, Intraosseous: 20 mg/kg/dose; may consider repeat dose in 10 minutes if clinically necessary (Ref).
Hypocalcemia, symptomatic: Note: Calcium gluconate may be the preferred salt due to lower extravasation risks which are greater during peripheral venous administration and due to potential for metabolic acidosis (Ref).
Neonates:
Intermittent IV infusion: Dose expressed as calcium chloride: 10 to 20 mg/kg/dose, may repeat every 4 to 6 hours as needed based on clinical response and desired effect (Ref).
Continuous IV infusion: Dose expressed as calcium chloride: Usual range: 3 to 11 mg/kg/hour (Ref).
Low cardiac output (adjunct therapy): Limited data available: Neonates: Dose expressed as calcium chloride: Continuous IV infusion: Initial: 5 to 10 mg/kg/hour. Dosing based on retrospective review of pediatric calcium chloride infusions (n=116 infusions [65 infusions in neonates]) for low cardiac output of surgical and nonsurgical etiologies (Ref). Another retrospective study did not show benefit of calcium chloride infusion following cardiac surgery (Ref).
Parenteral nutrition (PN), maintenance calcium requirement: Note: Calcium gluconate is the preferred salt formulation for the preparation of PN, as it is less reactive than calcium chloride (at equivalent amounts) and it allows for improved solubility with phosphate salts (Ref).
Neonates: Dose expressed as elemental calcium: IV: 2 to 4 mEq/kg/day as an additive to PN solution (Ref).
Dosage guidance:
Dosing: 1,000 mg of calcium chloride = 270 mg of elemental calcium = 14 mEq of elemental calcium.
Safety: Dosing may be presented as calcium chloride or as elemental calcium and expressed as mg or mEq; use caution.
Calcium channel blocker toxicity: Infants, Children, and Adolescents: Dose expressed as calcium chloride: IV: 10 to 20 mg/kg/dose infused over 5 to 10 minutes; if effective, may repeat bolus doses every 10 to 15 minutes or initiate continuous IV infusion at 20 to 50 mg/kg/hour (Ref).
Cardiac arrest in the presence of hyperkalemia or hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity (PALS recommendations): Note: Calcium chloride is the preferred salt in urgent situations; not recommended in the absence of hyperkalemia, hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity due to the lack of improved survival (Ref).
Infants, Children, and Adolescents: Dose expressed as calcium chloride: IV, Intraosseous: 20 mg/kg/dose, maximum dose: 2,000 mg/dose; may consider repeat dose in 10 minutes if clinically necessary (Ref).
Hypocalcemia, symptomatic: Note: Calcium gluconate may be the preferred salt in non-cardiac arrest settings due to extravasation risks which are greater during peripheral venous administration and due to potential for metabolic acidosis (Ref).
Infants, Children, and Adolescents: Dose expressed as calcium chloride: IV: 10 to 20 mg/kg/dose, maximum dose: 1,000 mg/dose; repeat as needed based on clinical response and desired effect; some experts suggest every 4 to 6 hours as needed (Ref).
Low cardiac output (adjunct therapy): Limited data available: Infants, Children, and Adolescents: Dose expressed as calcium chloride: Continuous IV infusion: 5 to 10 mg/kg/hour. Dosing based on retrospective report of pediatric calcium infusions (n=116 [51 infusions in ages 1 month to 17 years]) for low cardiac output of surgical and nonsurgical etiologies; study results did not show a statistically significant difference in improvement of cardiac output (Ref).
Parenteral nutrition (PN), maintenance calcium requirement: Note: Calcium gluconate is the preferred salt formulation for the preparation of PN since it is less reactive than calcium chloride (at equivalent amounts) and allows for improved solubility with phosphate salts (Ref).
Infants and Children ≤50 kg: Dose expressed as elemental calcium: IV: 0.5 to 4 mEq/kg/day as an additive to PN solution (Ref).
Children >50 kg and Adolescents: Dose expressed as elemental calcium: IV: 10 to 20 mEq/day as an additive to PN solution (Ref).
There are no dosage recommendations in the manufacturer's labeling.
There are no dosage recommendations in the manufacturer's labeling.
(For additional information see "Calcium chloride: Drug information")
Note: One gram of calcium chloride salt is equal to 270 mg of elemental calcium.
Dosages are expressed in terms of the calcium chloride salt (unless otherwise specified as elemental calcium). Dosages expressed in terms of the calcium chloride salt are based on a solution concentration of 100 mg/mL (10%) containing 1.4 mEq (27 mg) elemental calcium per mL.
Beta-blocker overdose (off-label use): Based on limited data: IV: Initial: Using a 10% solution: 20 mg/kg over 5 to 10 minutes (maximum: 1 to 2 g/dose); may repeat every 10 to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion of 20 to 40 mg/kg/hour titrated to improve hemodynamic response (Ref).
Calcium channel blocker overdose (off-label use): Based on limited data: IV: Initial: Using a 10% solution: 20 mg/kg over 5 to 10 minutes (maximum: 1 to 2 g/dose); may repeat every 10 to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion of 20 to 40 mg/kg/hour titrated to improve hemodynamic response (Ref). Note: Some recommend maintaining serum ionized calcium at a goal of twice normal (Ref).
Calcium replacement, during CRRT with citrate-based regional anticoagulation (off-label dose):
Intracircuit, posthemodialysis filter (returning to the patient) or IV through a separate central line: Prior to the initiation of CRRT, ensure adequate systemic ionized calcium concentrations (drawn directly from the patient). During CRRT, use a calcium chloride continuous infusion sliding scale to maintain systemic ionized calcium between ~3.6 to 5.2 mg/dL (~0.9 to 1.3 mmol/L); monitor systemic ionized calcium every 6 hours (or more frequently when indicated) (Ref). Refer to institutional protocols.
Hydrofluoric acid exposure (off-label use): Note: Consultation with a clinical toxicology or poison control center is recommended prior to the use of calcium chloride for hydrofluoric acid exposure.
Systemic toxicity: Note: Calcium chloride has been used in the treatment of systemic toxicity secondary to hydrofluoric acid exposure (Ref); however, calcium gluconate may be preferred due to the potential for more severe extravasation with calcium chloride.
IV: Exact dose has not been established; clinicians should tailor dose based on patient-specific needs (Ref). Bolus doses of up to 4 g have been required (Ref); repeat as needed based on symptoms of toxicity (eg, cardiac arrhythmias) and serum calcium concentration.
Hydrofluoric acid burns (severe): Intra-arterial: 10% solution: Add 10 mL of a 10% solution in 40 to 50 mL of D5W; infuse over 4 hours into the artery that provides the vascular supply to the affected area. Pain usually resolves by the end of the infusion; repeat if pain recurs (Ref); calcium gluconate may be preferred due to the potential for vessel injury and extravasation (Ref). This intervention should be used only by those accustomed to this technique. Care should be taken to avoid the extravasation. A poison information center or clinical toxicologist should be consulted prior to implementation.
Hyperkalemia , severe/emergent (off-label use): Note: Use in patients with hyperkalemia-associated ECG changes or serum potassium >6.5 mEq/L (Ref). Stabilizes myocardial cell membrane without impacting plasma potassium concentrations; must combine with insulin/dextrose to decrease plasma potassium levels and other therapies to eliminate potassium from body (Ref). Perform continuous cardiac monitoring and obtain serial ECGs (Ref).
IV, Intraosseous: Initial: 0.5 to 1 g over 2 to 5 minutes; may repeat after 5 minutes if ECG changes persist or recur, then every 30 to 60 minutes as needed (Ref).
Hypocalcemia, acute (alternative agent):
Note: For use in patients with severe symptoms of hypocalcemia (eg, tetany, seizures, carpopedal spasm), ECG abnormalities (eg, QTc prolongation, arrhythmia), or an acute decrease in albumin-corrected serum calcium levels to <7 to 7.5 mg/dL (<1.75 to 1.87 mmol/L) when serious complications may occur if untreated (eg, following neck surgery). In patients without a central line, calcium gluconate is preferred over calcium chloride due to the potential for more severe extravasation with calcium chloride. Correct concurrent hypomagnesemia if present (Ref). Do not use IV calcium as initial therapy in patients with chronic kidney disease who are asymptomatic or who have stable hypocalcemia with only mild symptoms (eg, paresthesias) (Ref).
Initial bolus dose(s): IV: Add 1 g (10 mL of a 10% solution) to 100 mL of D5W or NS (equivalent to 270 mg elemental calcium). Infuse via a central or large vein over 10 to 20 minutes; may repeat bolus dose after 10 to 60 minutes if symptoms persist (Ref). If hypocalcemia is expected to persist (eg, hypoparathyroidism, pancreatitis), follow bolus dose(s) with a continuous IV calcium infusion (Ref).
Continuous infusion: IV: Add 4 g (40 mL of a 10% solution) to 960 mL of D5W or NS (equivalent to ~1 g elemental calcium in a final total volume of 1,000 mL). Initiate infusion at 50 to 100 mL/hour (equivalent to ~50 to 100 mg/hour of elemental calcium) via a central or large vein; adjust dose to maintain albumin-corrected serum calcium levels at the low end of normal (Ref). Initiate oral calcium and vitamin D supplements as soon as possible; once an effective regimen is achieved, taper IV calcium infusion slowly (eg, over 24 to 48 hours) (Ref). Note: Instructions for preparing calcium chloride infusion are adapted from recommendations for calcium gluconate (Ref).
Note: Do not use IV calcium as initial therapy in patients with chronic kidney disease who are asymptomatic or who have stable hypocalcemia with only mild symptoms (eg, paresthesias) (Ref).
Initiate with lowest dose of the recommended dosage range.
There are no dosage adjustments provided in the manufacturer's labeling. No initial dosage adjustment necessary; subsequent doses should be guided by serum calcium concentrations.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing:
Cardiovascular: Cardiac arrhythmia (Carlon 1978), hypotension (Carlon 1978), peripheral vasodilation
Dermatologic: Cutaneous calcification (Ehsani 2006)
Gastrointestinal: Medicine-like taste (calcium taste)
Local: Injection-site reaction, localized burning
Patients with ventricular fibrillation; patients with asystole and electromechanical dissociation; concomitant use of IV calcium chloride with ceftriaxone in neonates (≤28 days of age).
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Extravasation: Vesicant; ensure proper catheter or needle position prior to and during infusion. Avoid extravasation. Extravasation may result in severe necrosis and sloughing. Monitor the IV site closely.
Disease-related concerns:
• Acidosis: Use with caution in patients with respiratory acidosis, renal impairment, or respiratory failure; acidifying effect of calcium chloride may potentiate acidosis.
• Hydrofluoric acid burns: Calcium chloride can be administered intra-arterially for severe hydrofluoric acid exposures. However, the chloride salt should never be injected into tissues (do not inject SUBQ or IM) due to the risk of tissue necrosis (Smith 2019). Consultation with a clinical toxicologist or a poison information center before using calcium chloride to treat hydrofluoric acid toxicity is recommended.
• Hyperphosphatemia: Use with caution in patients with severe hyperphosphatemia as elevated levels of phosphorus and calcium may result in soft tissue and pulmonary arterial calcium-phosphate precipitation.
• Hypokalemia: Use with caution in patients with severe hypokalemia as acute rises in serum calcium levels may result in life-threatening cardiac arrhythmias.
• Hypomagnesemia: Hypomagnesemia is a common cause of hypocalcemia; therefore, correction of hypocalcemia may be difficult in patients with concomitant hypomagnesemia. Evaluate serum magnesium and correct hypomagnesemia (if necessary), particularly if initial treatment of hypocalcemia is refractory.
• Renal impairment: Use with caution in patients with chronic renal failure to avoid hypercalcemia; frequent monitoring of serum calcium and phosphorus is necessary.
Concurrent drug therapy issues:
• Ceftriaxone: Ceftriaxone may complex with calcium causing precipitation. Fatal lung and kidney damage associated with calcium-ceftriaxone precipitates has been observed in premature and term neonates. Due to reports of precipitation reaction in neonates, do not coadminister ceftriaxone with calcium-containing solutions, even via separate infusion lines/sites or at different times in any neonate. Ceftriaxone should not be administered simultaneously with any calcium-containing solution via a Y-site in any patient. However, ceftriaxone and calcium-containing solutions may be administered sequentially of one another for use in patients other than neonates if infusion lines are thoroughly flushed (with a compatible fluid) between infusions.
• Digoxin: Use with caution in digitalized patients; hypercalcemia may precipitate cardiac arrhythmias.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.
Other warnings/precautions:
• Appropriate product selection: Multiple salt forms of calcium exist; close attention must be paid to the salt form when ordering and administering calcium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over or under dosing.
• Duration of use: Avoid metabolic acidosis (ie, administer only up to 2 to 3 days then change to another calcium salt).
• IV administration: For IV use only; do not inject SUBQ or IM. Avoid too rapid IV administration (do not exceed 100 mg/minute except in emergency situations); arrythmia, bradycardia, cardiac arrest, hypotension, syncope, and vasodilation may occur.
1 g calcium chloride = elemental calcium 270 mg = calcium 14 mEq = calcium 6.8 mmol
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 10% (10 mL)
Solution, Intravenous [preservative free]:
Generic: 10% (10 mL)
Yes
Solution (Calcium Chloride Intravenous)
10% (per mL): $0.89 - $2.43
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Calciject: 10% (10 mL, 50 mL)
Generic: 10% (10 mL)
Calcium salt |
Elemental calcium (mg/1 g of salt form) |
Calcium (mEq/g) |
---|---|---|
Calcium acetate |
253 mg |
12.7 mEq |
Calcium carbonate |
400 mg |
20 mEq |
Calcium chloride |
270 mg |
14 mEq |
Calcium citrate |
211 mg |
10.5 mEq |
Calcium glubionate |
63.8 mg |
3.2 mEq |
Calcium gluconate |
93 mg |
4.65 mEq |
Calcium lactate |
130 mg |
6.5 mEq |
Calcium phosphate (tribasic) |
390 mg |
19.3 mEq |
Parenteral: Do not use scalp vein or small hand or foot veins for IV administration; central-line administration is the preferred route. Not for endotracheal administration. Do not inject calcium salts IM or administer SUBQ since severe necrosis and sloughing may occur; extravasation of calcium can result in severe necrosis and tissue sloughing. Stop the infusion if the patient complains of pain or discomfort. Warm solution to body temperature prior to administration. Do not infuse calcium chloride in the same IV line as phosphate-containing solutions or with ceftriaxone.
IV: Avoid rapid administration; do not exceed 100 mg/minute except in emergency situations. For patients in cardiac arrest or with calcium channel blocker toxicity, administer as a bolus over 5 to 10 minutes via a central line or intraosseous route (Ref). For intermittent infusions, administer diluted solutions over >30 to 60 minutes via a central line (Ref).
Continuous IV infusion: Administer as a continuous infusion via an infusion pump.
Parenteral nutrition solution: Calcium chloride is not routinely used in the preparation of parenteral nutrition. Calcium-phosphate stability and precipitation in parenteral nutrition solution are dependent upon the pH of the solution, temperature, relative concentration of each ion, and salt formulation for Ca and PO4. Calcium chloride has a higher propensity to precipitate than calcium gluconate. The pH of the solution is primarily dependent upon the amino acid concentration and composition. The higher percentages of amino acids result in solutions with a lower pH, which decreases the risk for calcium and phosphate precipitation. Individual commercially available amino acid solutions vary significantly with respect to pH lowering potential and consequent calcium phosphate compatibility; consult product-specific labeling and solubility curve data for additional information (Ref).
Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Early/acute calcium extravasation: If acute extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry warm compresses; elevate extremity (Ref).
Delayed calcium extravasation: If delayed extravasation suspected, closely monitor site; most calcifications spontaneously resolve. However, if a severe manifestation of cutaneous calcinosis occurs, may initiate sodium thiosulfate antidote (Ref).
IV: For IV administration only. Not for IM or SUBQ administration (severe necrosis and sloughing may occur). Avoid rapid administration (do not exceed 100 mg/minute except in emergency situations). For patients in cardiac arrest, administer as a rapid bolus via a central line or intraosseous route (Ref). For intermittent IV infusion, infuse diluted solution over 1 hour or no greater than 45 to 90 mg/kg/hour (0.6 to 1.2 mEq/kg/hour); administration via a central or deep vein is preferred; do not use small hand or foot veins for IV administration (severe necrosis and sloughing may occur). Typical rates of administration may vary with indication; refer to institutional protocol. Monitor ECG if calcium is infused faster than 2.5 mEq/minute; stop the infusion if the patient complains of pain or discomfort. Warm solution to body temperature prior to administration. Do not infuse calcium chloride in the same IV line as phosphate-containing solutions.
Hydrofluoric acid burns (severe) (off-label use/route): Intra-arterial: Requires radiology to place an arterial catheter in an artery supplying blood to the area of exposure; infuse over 4 hours (Ref). This intervention should be used only by those trained in this technique. Care should be taken to avoid the extravasation. A poison information center or clinical toxicologist should be consulted prior to implementation.
Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Extravasation management:
Early/acute calcium extravasation: If extravasation occurs, stop infusion immediately; leave needle/cannula in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate hyaluronidase antidote (Ref).
Hyaluronidase: Intradermal or SUBQ: Inject a total of 1 to 1.7 mL (15 units/mL) as 5 separate 0.2 to 0.3 mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer intravenously through the infiltrated catheter; may repeat in 30 to 60 minutes if no resolution (Ref).
Delayed calcium extravasation: Closely monitor site; most calcifications spontaneously resolve. However, if a severe manifestation of calcinosis cutis occurs, may initiate sodium thiosulfate antidote.
Sodium thiosulfate: IV: 12.5 g over 30 minutes, administered 3 times per week; may increase gradually to 25 g 3 times per week; monitor for non-anion gap acidosis, hypocalcemia, severe nausea (Ref).
Store intact vials at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Do not refrigerate solutions; IV infusion solutions in D5W, LR, NS, or other appropriate solutions are stable for 24 hours at room temperature.
Although calcium chloride is not routinely used in the preparation of parenteral nutrition, it is important to note that phosphate salts may precipitate when mixed with calcium salts. Solubility is improved in amino acid parenteral nutrition solutions. Check with a pharmacist to determine compatibility.
Pharmacy supply of emergency antidotes: Guidelines suggest that at least 10 g of calcium chloride be stocked. Suggested amount is stated to be a sufficient quantity to provide antidotal treatment for 1 patient weighing 100 kg for an initial 8- to 24-hour period (Dart 2018); actual amount to be stocked should take into account site-specific and population-specific needs.
Treatment of acute, symptomatic hypocalcemia (FDA approved in pediatric patients [age not specified] and adults); has also been used for calcium channel blocker toxicity, treatment of low cardiac output, treatment of symptomatic hyperkalemia or hypermagnesemia, parenteral nutrition, and post-cardiac arrest resuscitation.
Calcium chloride may be confused with calcium gluconate
Calcium chloride may be confused with calcium gluconate.
Confusion with the different intravenous salt forms of calcium has occurred. There is a threefold difference in the primary cation concentration between calcium chloride (in which 1 g = 14 mEq [270 mg] of elemental Ca++) and calcium gluconate (in which 1 g = 4.65 mEq [93 mg] of elemental Ca++).
Prescribers should specify which salt form is desired. To prevent medication errors, dosages should be expressed either as mg or grams of the salt form for most indications. Dosages expressed as mEq may be used for nutrition.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Risk X: Avoid combination
Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cardiac Glycosides: Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy
CefTRIAXone: Calcium Salts (Intravenous) may enhance the adverse/toxic effect of CefTRIAXone. Ceftriaxone binds to calcium forming an insoluble precipitate. Management: Use of ceftriaxone is contraindicated in neonates (28 days of age or younger) who require (or are expected to require) treatment with IV calcium-containing solutions. In older patients, flush lines with compatible fluid between administration. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
Multivitamins/Fluoride (with ADE): May increase the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). More specifically, calcium salts may impair the absorption of fluoride. Management: Avoid eating or drinking dairy products or consuming vitamins or supplements with calcium salts one hour before or after of the administration of fluoride. Risk D: Consider therapy modification
Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of Calcium Salts. Risk C: Monitor therapy
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Risk D: Consider therapy modification
Roxadustat: Polyvalent Cation Containing Products may decrease the serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider therapy modification
Thiazide and Thiazide-Like Diuretics: May increase the serum concentration of Calcium Salts. Risk C: Monitor therapy
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider therapy modification
Unithiol: May diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination
Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Risk C: Monitor therapy
Calcium crosses the placenta. The amount of calcium reaching the fetus is determined by maternal physiological changes. Calcium requirements are the same in pregnant and nonpregnant females (IOM 2011).
Information related to use as an antidote in pregnancy is limited. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the nonpregnant woman. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (AHA [Jeejeebhoy 2015]).
Serum calcium (ionized calcium preferred if available), albumin, phosphate, magnesium, heart rate, ECG when clinically appropriate.
Note: Ranges may slightly vary by individual laboratories.
Age |
Serum concentration | |
---|---|---|
Calcium, total |
Cord blood |
9 to 11.5 mg/dL (SI: 2.3 to 2.9 mmol/L) |
Newborn 3 to 24 hours |
9 to 10.6 mg/dL (SI: 2.3 to 2.7 mmol/L) | |
24 to 48 hours |
7 to 12 mg/dL (SI: 1.8 to 3 mmol/L) | |
4 to 7 days |
9 to 10.9 mg/dL (SI: 2.3 to 2.7 mmol/L) | |
Child |
8.8 to 10.8 mg/dL (SI: 2.2 to 2.7 mmol/L) | |
Adolescent to Adult |
8.4 to 10.2 mg/dL (SI: 2.1 to 2.6 mmol/L) | |
Calcium, ionized, whole blood |
Cord blood |
5 to 6 mg/dL |
Newborn 3 to 24 hours |
4.3 to 5.1 mg/dL | |
24 to 48 hours |
4 to 4.7 mg/dL | |
≥2 days |
4.8 to 4.92 mg/dL (2.24 to 2.46 mEq/L) |
Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended.
In low albumin states if ionized calcium in unavailable, the corrected total serum calcium may be estimated by this equation (assuming a normal albumin of 4 g/dL [SI: 40 g/L]):
Corrected total calcium (mg/dL) = measured serum calcium (mg/dL) + 0.8 (4 − measured serum albumin [g/dL])
Moderates nerve and muscle performance via action potential excitation threshold regulation.
In hydrofluoric acid (hydrogen fluoride) exposures, calcium chloride provides an exogenous source of calcium which can bind fluoride ions as well as treat and prevent complications secondary to hypocalcemia; intra-arterial administration can reduce the penetration of the fluoride ion into tissues and prevent or reduce tissue destruction and pain (Vance 1986; Wu 2010).
Distribution: Primarily in skeleton (99%).
Protein binding: ~40%, primarily to albumin.
Excretion: Primarily feces (80% as insoluble calcium salts); urine (20%) (IOM 2011).
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