Calcium Chloride*

• Calcium Chloride

Classification:

• Electrolyte

Mechanism of Action:

• Increases myocardial contractility and ventricular automaticity.
• Stabilizes overly excited myocardial cells in the presence of hyperkalemia. Increased extracellular potassium causes the cellular membrane action potential to decrease which may lead to ECG changes and pre-excitation arrhythmias.

Indications:

• Cardiac arrest patients with suspected hyperkalemia (DKA, renal failure, calcium channel blocker overdose).
• Suspected hyperkalemia with cardiovascular toxicity (wide QRS, peaked T waves and/or sine wave or hemodynamic instability).
• Calcium channel blocker overdose with symptomatic bradycardia or hemodynamic instability.
• Respiratory depression after infusion of magnesium sulfate (decreased diaphragm neuromuscular action).

Contraindications:

• VFib
• Digitalis toxicity
• Hypercalcemia
• Renal or cardiac disease

Precautions:

• Severe local necrosis (infiltration)
• Always flush the line between doses of calcium and bicarbonate to avoid precipitation.
• Ensure the line is patent before calcium administration as to avoid extravasation.
• Consider consulting the Atlantic Canada Poison Centre in the setting of suspected calcium channel blocker overdose.
• Calcium chloride is not the definitive treatment for hyperkalemia. Patients will require treatment with salbutamol, insulin, and possibly renal dialysis at a healthcare facility.
• Routine administration of calcium chloride for cardiac arrest is not recommended.
• Pregnancy category C [if the patient will benefit from a Category C drug, it is generally used]

Adverse Effects:

• Bradycardia
• Hypotension
• Metallic taste
• Cardiac arrest
• Syncope
• Vomiting

Dose:

Adult:

• 1 g over 3 minutes, repeat x 1 in 10 minutes if indications still present. 

• Cardiac arrest: 20 mg/kg (maximum single dose of 1 g) over 3 minutes, repeat x 1 in 10 minutes if indications still present.
• Non-arrest: 10 mg/kg (maximum single dose of 1 g) over 15 minutes, repeat x 1 in 10 minutes if indications still present.

• IV, IO

• Compendium of Pharmaceuticals and Specialties (CPS)