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Drug Details

Calcium Chloride Injection

• Drug Class Description
  Calcium supplements.
• Generic Name
  Generic
• Presentation
  Sterile aqueous solution for intracardiac or slow intravenous administration.
• Description
  Calcium Chloride Dihydrate USP 100mg in 1ml (0.68mmol/ml).
• Indications
  Calcium Chloride Injection 10% w/v is indicated in the immediate treatment of hypocalcaemic tetany. Other therapy, such as parathyroid hormone and/or vitamin D, may be indicated according to the etiology of the tetany. It is also important to institute oral calcium therapy as soon as practicable. In cardiac resuscitation, particularly after open heart surgery, calcium chloride has been used when adrenaline has failed to improve weak or ineffective myocardial contractions. Calcium salts have been used as adjunctive therapy in a number of conditions, including the following: 1. In severe hyperkalaemia, calcium may be injected slowly while the ECG is monitoring the heart. 2. As an aid in the treatment of depression due to overdosage of magnesium sulphate (calcium is the antagonist of magnesium toxicity). Routes of administration: For intracardiac or slow intravenous use only.
• Adult Dosage
  

  Intracardiac use:

  In cardiac resuscitation, injection may be made into the ventricular cavity. Do not inject into the myocardium.

  Adult dosage: 200-400mg (2-4ml)

  Paediatric dosage: 0.2ml/kg of bodyweight.

  Intravenous use:

  Hypocalcaemic disorders

  Adult dosage: 500mg to 1g (5-10ml) at intervals of 1 to 3 days, depending on response of the patient or serum calcium determinations. Repeated injection may be required.

  Paediatric dosage: 0.2ml/kg of bodyweight. Maximum 1-10ml/day.

  Magnesium Intoxication

  Adult dosage: 500mg (5ml) administered promptly. Observe patient for signs of recovery before further doses are given.

  Hyperkalaemic ECG disturbances of cardiac function

  Adult dosage: Adjust dosage by constant monitoring of ECG changes during administration.

  Geriatric patient dosage is the same as an adult.

• Child Dosage
  Dosage is determined by a paediatrician and is dependent on the requirements of the patient. Plasma calcium must be monitored. 2 to 12 years: 0.5 millimoles to  2 to 12 years: 0.5 millimoles to 3.5 millimoles by intravenous infusion after dilution with at least 4 times its volume of Sodium Chloride Intravenous Infusion BP (0.9% w/v). The dose may be repeated every one to three days. Under 2 years: less than 0.5 millimoles by intravenous infusion after dilution with at least 4 times its volume of Sodium Chloride Intravenous Infusion BP (0.9% w/ v). The dose may be repeated every one to three days.
• Contra Indications
  

  In cardiac resuscitation, the use of calcium is contraindicated in the presence of ventricular fibrillation. Calcium chloride injection is contraindicated for injection into tissue (subcutaneous or intramuscular) as it may cause necrosis and sloughing.

  Calcium chloride is also contraindicated in those patients with conditions associated with hypercalcaemia and hypercalcuria (e.g. some forms of malignant disease) or in those with conditions associated with elevated vitamin D levels (e.g. sarcoidosis) or in those with renal calculi or a history of calcium renal calculi.

• Special Precautions
  

  A  moderate fall in blood pressure due to vasodilation may attend the injection. Since calcium chloride is an acidifying salt, it is usually undesirable in the treatment of hypocalcaemia of renal insufficiency.

  Calcium chloride injection, 10% w/v is for intracardiac or slow intravenous injection only. Care should be taken not to infiltrate the perivascular tissue due to possible necrosis. Solutions should be warmed to body temperature. Injections should be made slowly through a small needle into a large vein to minimize venous irritation and avoid undesirable reactions.

  It is particularly important to prevent a high concentration of calcium from reaching the heart because of danger of cardiac syncope. If injected into the ventricular cavity in cardiac resuscitation care must be taken to avoid injection into the myocardial tissue. Calcium chloride injection should never be given to infants orally because of severe irritation to the gastrointestinal tract. Infant injections should not be given through the scalp.

  The use of calcium chloride is undesirable in patients with respiratory acidosis or respiratory failure due to the acidifying nature of the salt.

• Interactions
  

  Because of the danger involved in the simultaneous use of calcium salts and drugs of the digitalis group, a digitalized patient should not receive an intravenous injection of a calcium compound unless the indications are clearly defined. Calcium salts should not generally be mixed with carbonates, phosphates, sulphates or tartrate in parenteral mixtures.

  Biphosphonates may interact with calcium chloride causing reduced absorption of biphosphates. Thiazide diuretics may increase the risk of hypercalcaemia.

• Adverse Drug Reactions
  

  Rapid intravenous injections may cause the patient to complain of tingling sensations, a calcium taste, a sense of oppression or “heat wave”. Injections of calcium chloride are accompanied by peripheral vasodilation as well as a local burning sensation and there may be a moderate fall in blood pressure.

  Necrosis and sloughing with subcutaneous or intramuscular administration or if extravasation occurs have been reported. Soft tissue calcification, bradycardia or arrhythmias have also been reported.