Parenteral Manual

Calcium Chloride

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Calciject
Classification: 
Electrolyte
Original Date: 
Oct 2024
Indications: 
  • Calcium replacement during CRRT with citrate-based anticoagulation 
  • NOT to be used for calcium replacements in other clinical situations (please see calcium gluconate for further management outside of CRRT) 
Reconstitution and Stability: 
  • Supplied as 50 mL vials of 100 mg/mL (10%, 0.68 mmol/mL, 1.36 mEq/mL of calcium ions) 
  • Store vials in original carton at room temperature (15 - 30°C), do not freeze 
  • Diluted solution stable for 24 hours at room temperature 

 

Available Form: 

  1. Premixed BAG of calcium chloride 8 mg/mL (0.8%) 
    Available from Pharmacy 
    Administer via LARGE VOLUME PUMP for calcium replacement during CRRT using citrate anticoagulation 
Compatibility: 
  • Solutions compatible: 0.9% Sodium Chloride, D5W, lactated ringers 
  • Additives/Above Cassette Compatible: Unknown 
  • Y-Site compatibility: dopamine, dexmedetomidine, epinephrine, fentanyl, furosemide, hydromorphone, midazolam, morphine, nitroprusside, norepinephrine, heparin 
  • Incompatible: phosphate salts, TPN (calcium chloride has a higher likelihood of precipitation than calcium gluconate), ceftriaxone, pantoprazole 
Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion NO
IV Continuous Infusion

YES - LARGE VOLUME PUMP

Usual dilution: 8 mg/mL 

Infusion rate: do not exceed 100 mg/minute or 45 to 90 mg/kg/hour (0.6 to 1.2 mEq/kg/hour)

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • CRRT blood flow rate (BFR, mL/HOUR) x 0.6 = ______ mL/h (Max 1.5 x BFR in mL/min) 
Potential hazards of parenteral administration: 
  • Administer via central line, if possible, due to risk of severe necrosis secondary to extravasation. 
  • Do not infuse calcium chloride in the same IV line as phosphate-containing solutions.  
  • Rapid IV administration can result in cardiotoxicity (bradycardia, dysrhythmias), hypotension, local thrombophlebitis, tingling sensation, calcium taste, flushing, nausea, vomiting, sweating, dizziness, confusion. 
  • Calcium chloride is a vesicant and will cause irritation on extravasation resulting in tissue necrosis and sloughing. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.   
  • SC, IM routes are NOT recommended due to possibility of severe sloughing, necrosis, abscess formation. 
  • Avoid administration via scalp veins or small hand or foot veins. 
Notes: 
  • Calcium chloride and calcium gluconate are not the same concentration of calcium and should not be used interchangeably. Specifically, 1 g of calcium chloride contains 14 mEq (270 mg) of elemental calcium, while 1 g of calcium gluconate contains 4.65 mEq (93 mg) of elemental calcium. 
  • Use with caution in patients with severe hyperphosphatemia – may result in calcium-phosphate precipitation in soft tissues and pulmonary arteries. 
  • Use with caution in patients with hypokalemia – acute rise in serum calcium can result in cardiac arrhythmias.  
References: 
  • Calciject Monograph, Omega Laboratories Limited 
  • Calciject (Calcium Chloride), LexiComp 

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