Yes

Calcium Salt; Electrolyte Supplement, Parenteral

Cardiac resuscitation when epinephrine fails to improve myocardial contractions, cardiac disturbances of hyperkalemia, hypocalcemia, or calcium channel blocking agent toxicity; emergent treatment of hypocalcemic tetany, treatment of hypermagnesemia

C

In ventricular fibrillation during cardiac resuscitation, hypercalcemia, and in patients with risk of digitalis toxicity, renal or cardiac disease

Avoid too rapid I.V. administration (<1 mL/minute) and extravasation; use with caution in digitalized patients, respiratory failure, or acidosis; hypercalcemia may occur in patients with renal failure, and frequent determination of serum calcium is necessary; avoid metabolic acidosis (ie, administer only 2-3 days then change to another calcium salt)

<1%: Vasodilation, hypotension, bradycardia, cardiac arrhythmias, ventricular fibrillation, syncope, lethargy, coma, mania, erythema, decreased serum magnesium, hypercalcemia, elevated serum amylase, tissue necrosis, muscle weakness, hypercalciuria

Symptoms of overdose include lethargy, nausea, vomiting, coma

Following withdrawal of the drug, treatment consists of bed rest, liberal intake of fluids, reduced calcium intake, and cathartic administration. Severe hypercalcemia requires I.V. hydration and forced diuresis. Urine output should be monitored and maintained at >3 mL/kg/hour. I.V. saline and natriuretic agents (eg, furosemide) can quickly and significantly increase excretion of calcium.

Decreased effect: Calcium may antagonize the effects of calcium channel blockers, atenolol, and sodium polystyrene sulfonate

Increased toxicity: Administer cautiously to a digitalized patient, may precipitate arrhythmias; hypercalcemia induced by thiazides may be increased with calcium administration

Do not refrigerate solutions; IVPB solutions/I.V. infusion solutions are stable for 24 hours at room temperature

Maximum concentration in parenteral nutrition solutions: 15 mEq/L of calcium and 30 mmol/L of phosphate

Incompatible with sodium bicarbonate, carbonates, phosphates, sulfates, and tartrates

Moderates nerve and muscle performance via action potential excitation threshold regulation

Absorption: I.V. calcium salts are absorbed directly into the bloodstream

Distribution: Crosses the placenta; appears in breast milk

Elimination: Mainly in feces as unabsorbed calcium with 20% eliminated by the kidneys

Note: Calcium chloride is 3 times as potent as calcium gluconate

Infants and Children: 20 mg/kg; may repeat in 10 minutes if necessary

Adults: 2-4 mg/kg (10% solution), repeated every 10 minutes if necessary

Hypocalcemia: I.V.:

Infants and Children: 10-20 mg/kg/dose (infants <1 mEq; children 1-7 mEq), repeat every 4-6 hours if needed

Adults: 500 mg to 1 g (7-14 mEq)/dose repeated every 4-6 hours if needed

Hypocalcemic tetany: I.V.:

Infants and Children: 10 mg/kg (0.5-0.7 mEq/kg) over 5-10 minutes; may repeat after 6-8 hours or follow with an infusion with a maximum dose of 200 mg/kg/day

Adults: 1 g over 10-30 minutes; may repeat after 6 hours

Hypocalcemia secondary to citrated blood transfusion: I.V.:

Neonates: Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused

Adults: 1.35 mEq calcium with each 100 mL of citrated blood infused

Dosing adjustment in renal impairment: Cl_cr <25 mL/minute: Dosage adjustments may be necessary depending on the serum calcium levels

Rapid I.V. injection at a maximum rate of 50 mg/minute; for I.V. infusion, dilute to a maximum concentration of 20 mg/mL and infuse over 1 hour or no greater than 45-90 mg/kg/hour (0.6-1.2 mEq/kg/hour)

Serum calcium: 8.4-10.2 mg/dL

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, the corrected total serum calcium may be estimated by this equation (assuming a normal albumin of 4 g/dL)

Corrected total calcium = total serum calcium + 0.8 (4.0 - measured serum albumin)

or

Corrected calcium = measured calcium - measured albumin + 4.0

Serum/plasma chloride: 95-108 mEq/L

calcium (S); magnesium

May cause drowsiness; rare reports of mania

None reported

No information available to require special precautions

No effects or complications reported

This medication can only be given I.V. Do not make rapid postural changes while calcium is infusing. Report any feelings of excitation, chest pain, irregular or pounding heartbeat, vomiting, acute headache, or dizziness. Consult prescriber if breast-feeding.

Do not inject calcium chloride I.M. or administer S.C. or use scalp, small hand or foot veins for I.V. administration since severe necrosis and sloughing may occur. Monitor EKG if calcium is infused faster than 2.5 mEq/minute; usual: 0.7-1.5 mEq/minute (0.5-1 mL/minute); stop the infusion if the patient complains of pain or discomfort. Warm to body temperature; administer slowly, do not exceed 1 mL/minute (inject into ventricular cavity - not myocardium); do not infuse calcium chloride in the same I.V. line as phosphate-containing solutions.

Hyaluronidase: Add 1 mL NS to 150 unit vial to make 150 units/mL of concentration; mix 0.1 mL of above with 0.9 mL NS in 1 mL syringe to make final concentration = 15 units/mL

Elemental calcium listed in brackets

Bilezikian JP, "Management of Acute Hypercalcemia," N Engl J Med, 1992, 326(18):1196-215.

Binder LS, "Acute Arthropod Envenomation: Incidence, Clinical Features, and Management," Med Toxicol Adverse Drug Exp, 1989, 4(3):163-73.

Chin RL, Garmel GM, and Harter PM, "Development of Ventricular Fibrillation After Intravenous Calcium Chloride Administration in a Patient With Supraventricular Tachycardia," Ann Emerg Med, 1995, 25(3):416-9.

McIvor ME, "Acute Fluoride Toxicity. Pathophysiology and Management," Drug Saf, 1990, 5(2):79-84.

Pearigen PD and Benowitz NL, "Poisoning Due to Calcium Antagonists. Experience With Verapamil, Diltiazem, and Nifedipine," Drug Saf, 1991, 6(6):408-30.

Slattery A, King WD, Nichols M, et al, "Hypercalcemia Following Damp-Rid™ Ingestion," Clin Toxicol, 1995, 33(5):487.

Worthley LI and Phillips PJ, "Intravenous Calcium Salts," Lancet, 1980, 2(8186):149.