Calcium Chloride

Antidote

Adult

Calcium Chloride

ALERT: Central line or large vein is preferred to avoid extravasation

Indications

Hypotension and bradycardia due to calcium channel blocker or beta blocker overdose.
Systemic hypocalcemia due to hydrofluoric acid exposure or ethylene glycol toxicity. (Calcium gluconate preferred; see monograph)

Dosage

1 g (10 mL of a 10% calcium chloride injection) IV direct over 10 minutes.
Repeat every 10 - 20 minutes as required; after four doses, monitor serum calcium levels and reassess. If effective for reversing hypotension and bradycardia, continue with this regimen. If ineffective, further treatment should focus on other, more effective antidotes (see Insulin, Glucagon and Lipid Emulsion monographs).

Administration

IV Direct: May administer 10% calcium chloride undiluted at a rate of
0.5 to 1 mL/minute (50 - 100 mg/minute). Cardiac monitoring and blood pressure monitoring are required.

Compatibility, Stability

Compatible with sodium chloride 0.9%, dextrose 5% in water, dextrose-saline combinations.

Potential Hazards of Administration

Flushing, nausea, vomiting, drowsiness, hypotension and chalky or metallic taste.
Sweating, tingling sensations, “heat waves”, tissue irritation and necrosis.
Rapid IV administration may cause vasodilation, hypotension, bradycardia, cardiac arrhythmia, syncope and cardiac arrest.
Hypercalcemia. Symptoms include lethargy, nausea, vomiting or coma.
Hypersensitivity reactions.

Miscellaneous

Monitor serum calcium every 2 to 4 hours during therapy. Normal total serum calcium: 2.19 - 2.54 mmol/L.
Contraindicated in management of ventricular fibrillation. Do not use routinely in cardiac arrest.
Caution in patients receiving digoxin concomitantly. Rapid IV administration may cause bradycardia or asystole.
If necessary, administer digoxin Fab fragments first and then at least 30 minutes later, administer calcium.
In hypoalbuminemic patients, the corrected total serum calcium can be estimated with the formula: corrected calcium (mmol/L) = total measured calcium (mmol/L) + [0.02 x {40-albumin (g/L)}]. Ionized calcium may also be measured.
Magnesium levels should be checked and hypomagnesemia treated if present.

References…

Bailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). Antidotes en toxicologie d'urgence (3rd ed.). Quebec, Canada: Centre antipoison du Quebec.

Borron, S. W., Bronstein, A. C., Fernandez, M. C., & et all. (2014). Walter F. G. (Ed.), AHLS advanced hazmat life support, provider manual (4th ed.). Tucson, Arizona: The University of Arizona College of Medicine.

Goldfrank, L. R., Nelson, L. S., Lewin, N. A., Howland, M. A., Hoffman, R. S., (2015). Goldfrank's toxicologic emergencies(Tenth ed.). New York: McGraw Hill.

IWK Regional Poison Centre. (2011). Beta-adrenergic antagonists (beta-blockers): A brief overview for emergency departments. Unpublished manuscript.

IWK Regional Poison Centre. (2011). Calcium channel blockers: A brief overview for emergency departments. Unpublished manuscript.

Micromedex, T. H. A. (2014). Micromedex health care systems. Retrieved from http://www.micromedexsolutions.com

Olson, K. R. (2007). Poisoning & drug overdose (Sixth ed.). New York: McGraw Hill.

Phelps SJ, C. C. (2013). Teddy bear, pediatric injectable drugs. Retrieved from http://www.pharmpress.com/product/MC_PED/pediatric-injectable-drugs

Shannon, M. W., Borron, S. W., & Burns, M. J. (2007). Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Philadelphia: Saunders Elsevier.

Trissel, Lawrence, A,. (2013). Handbook on injectable drugs (17th ed.). Bethesda, Maryland: American Society of Health-System Pharmacists