Calcium Chloride or Gluconate
⚠️ IV Calcium is life-saving in certain emergencies (e.g. severe hyperkalaemia, hypocalcaemia), but must be used with great care.
💡 Danger: IV calcium can provoke arrhythmias if given to patients on digoxin with low potassium. Always ECG monitor.
🔗 Always check the BNF before use:
Calcium Chloride
|
Calcium Gluconate
📖 About
- Used in resuscitation/emergency medicine, often supplied as a Mini-Jet on the arrest trolley.
- Main role: Cardioprotection (e.g. stabilises myocardium in severe hyperkalaemia).
⚙️ Mode of Action
- Raises extracellular calcium → stabilises cardiac myocyte membranes.
- Buys time by reducing risk of arrhythmia until definitive correction (e.g. insulin/dextrose, dialysis).
💉 Formulations
- Calcium chloride: More potent but very irritant → best via central line (risk of tissue necrosis if extravasated).
- Calcium gluconate: Preferred if no central access (safer in peripheral veins).
📌 Indications
- Severe hyperkalaemia (K⁺ > 6.5 mmol/L with ECG changes).
- Severe hypocalcaemia (e.g. tetany, seizures).
- Calcium channel blocker overdose.
- Magnesium toxicity (e.g. excessive Mg infusion).
💊 Doses
- Hyperkalaemia: 10–20 mL calcium gluconate 10% IV. Repeat if ECG abnormalities persist.
✔️ Effect = narrowing of QRS / restoration of more normal ECG.
- Hypocalcaemia: 10 mL calcium gluconate 10% IV diluted in 100 mL 0.9% NaCl or 5% glucose, infused over 10–20 min.
➡️ In emergencies (e.g. tetany) may give neat, slowly, over ≥3 min with ECG monitoring.
- Infusions: Gluconate preferred for prolonged correction (less irritant).
🚫 Contraindications
- Absolute: Digoxin toxicity, Hypercalcaemia.
⚠️ Interactions
- ❌ Do not mix with bicarbonate or phosphate → precipitates.
- ⚡ Digoxin + IV calcium = risk of fatal arrhythmias (especially with hypokalaemia).
❗ Side Effects
- Local: Pain, phlebitis, severe tissue necrosis if extravasated.
- Systemic (rapid IV): Hot flush, hypotension, bradycardia, arrhythmias, cardiac arrest.
- Oral: GI upset (nausea, constipation, diarrhoea). Interferes with absorption of tetracyclines, iron, bisphosphonates → leave 3 hrs gap.
📚 References
