Calcium Chloride
Calcium Chloride in Pediatric Emergency Medicine
Calcium chloride is a rapidly acting electrolyte replacement agent used in various emergency situations in pediatrics. It provides a higher concentration of elemental calcium compared to calcium gluconate, making it particularly useful in critical care settings.
Key Points:
- Rapid-acting calcium source
- Higher elemental calcium concentration than calcium gluconate
- Used in life-threatening hypocalcemia and specific cardiac emergencies
- Requires careful administration due to potential tissue damage if extravasation occurs
Indications for Calcium Chloride Use in Pediatrics
- Severe hypocalcemia (e.g., in neonatal tetany)
- Hyperkalemia with ECG changes
- Calcium channel blocker overdose
- Magnesium sulfate toxicity
- As part of advanced cardiac life support protocols
- Treatment of hypermagnesemia
- Management of hydrofluoric acid burns
Dosage and Administration
Standard Dose: 20 mg/kg IV (0.2 mL/kg of 10% solution)
Maximum Dose: 1 gram (10 mL of 10% solution)
Administration Guidelines:
- Administer through a secure central line when possible
- If given peripherally, ensure IV patency
- Dilute to 1:1 or 1:2 with D5W or NS
- Infuse slowly over 5-10 minutes (cardiac arrest: give as slow IV push)
- Maximum infusion rate: 0.5 mL/kg/min (50 mg/kg/min) of 10% solution
Precautions and Side Effects
Precautions:
- Use with caution in patients with renal or cardiac disease
- Avoid in patients with hypercalcemia or digitalis toxicity
- Monitor for signs of hypercalcemia
Side Effects:
- Tissue necrosis if extravasation occurs
- Rapid injection may cause vasodilation, hypotension, bradycardia, arrhythmias, syncope, and cardiac arrest
- Nausea, vomiting, abdominal pain
- Flushing, chalky taste
- Hypercalcemia (with excessive doses)
Monitoring
- Continuous cardiac monitoring during administration
- Frequent blood pressure checks
- Serial serum calcium levels
- ECG monitoring for changes in QT interval and other signs of electrolyte imbalance
- Watch for signs of extravasation at the injection site
- Monitor for signs of hypercalcemia: confusion, lethargy, muscle weakness, constipation
