CALCIUM CHLORIDE 10%
Clinical safety rating
cautionComprehensive clinical and safety monograph for CALCIUM CHLORIDE 10% (CALCIUM CHLORIDE 10%).
Calcium chloride dissociates to provide calcium ions, which are essential for myocardial contractility, nerve impulse transmission, and blood coagulation. It antagonizes the cardiotoxic effects of hyperkalemia by stabilizing cardiac cell membrane potential.
| Metabolism | Calcium chloride is not metabolized; it is excreted primarily in the urine with reabsorption regulated by the kidneys and parathyroid hormone. |
| Excretion | Primarily renal (>80% as ionized calcium); minor fecal elimination (10-20%) via endogenous secretion; negligible biliary excretion. |
| Half-life | Terminal half-life ~4-6 hours for rapid distribution phase; prolonged in renal impairment (up to 24-48 hours). |
| Protein binding | Approximately 45-50% bound to albumin; 10-15% complexed with citrate, phosphate, or bicarbonate. |
| Volume of Distribution | 0.3-0.4 L/kg (primarily extracellular fluid). Increased in hypocalcemia or hypoalbuminemia. |
| Bioavailability | IV/IO: 100%. Not administered orally for systemic effect due to GI irritation and poor absorption; oral bioavailability is negligible (<1%) if ingested. |
| Onset of Action | IV: Immediate (seconds to minutes). Intracardiac: Seconds. Intraosseous: Within 1-2 minutes. |
| Duration of Action | IV: 30-60 minutes for cardiac effects; 2-4 hours for serum calcium elevation (dose-dependent). |
| Molecular Weight | 110.98 |
IV: 500 mg to 1 g (5-10 mL of 10% solution) administered slowly at a rate not exceeding 0.5-1 mL/min; may be repeated every 1-3 days based on serum calcium levels.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR <30 mL/min: Use with caution, reduce dose by 50% and monitor serum calcium closely; eGFR <15 mL/min: Avoid use if possible, if necessary use lowest effective dose with frequent monitoring. |
| Liver impairment | No specific dose adjustment required for Child-Pugh class A, B, or C; monitor serum calcium due to potential for altered vitamin D metabolism. |
| Pediatric use | IV: 10-20 mg/kg of elemental calcium (0.1-0.2 mL/kg of 10% solution) given slowly (not exceeding 0.5 mL/min). Maximum single dose: 500 mg (5 mL). May repeat in 4-6 hours if needed. |
| Geriatric use | Start at lower end of dosing range (e.g., 500 mg IV), administer at a slower rate (over 10-15 minutes) due to higher risk of hypercalcemia and cardiovascular effects; monitor renal function and serum calcium frequently. |
| 1st trimester | Intravenous calcium chloride is used in emergency management of severe hypocalcemia. No known teratogenic effects in animal studies. Use only if clearly needed. |
| 2nd trimester | May be used for maternal indications; monitor fetal heart rate during administration due to risk of bradycardia. |
| 3rd trimester | May cause hypercalcemia in neonate if administered near term; avoid unless necessary for maternal resuscitation. |
Clinical note
Comprehensive clinical and safety monograph for CALCIUM CHLORIDE 10% (CALCIUM CHLORIDE 10%).
| Placental transfer | Calcium crosses the placenta by active transport; levels are maintained in fetal circulation. Intravenous administration may increase fetal calcium concentrations. |
| Breastfeeding | Calcium is a normal component of breast milk. Intravenous calcium chloride is unlikely to significantly increase milk calcium levels. Use with caution due to potential maternal adverse effects. |
| Lactation Rating | L2 - Probably Compatible |
| Teratogenic Risk | Animal reproduction studies have not been conducted with calcium chloride. It is not known whether calcium chloride can cause fetal harm when administered to a pregnant woman. Calcium is an essential mineral for fetal development; however, high doses may lead to hypercalcemia in the mother and fetus. In the first trimester, no specific teratogenic risk is documented; however, maternal hypercalcemia from excessive supplementation may interfere with placental calcium transport and fetal bone development. In the second and third trimesters, excessive doses may cause fetal hypoparathyroidism, hypercalcemia, and potential neonatal hypocalcemia due to suppression of the fetal parathyroid gland. Use only if clearly needed and with caution. |
| Fetal Monitoring | Monitor maternal serum calcium, ionized calcium, and phosphate levels frequently during therapy. Assess for signs of hypercalcemia: polyuria, constipation, muscle weakness, confusion, and cardiac arrhythmias (QT shortening). Fetal monitoring: In pregnancy, consider serial fetal ultrasound to assess for growth restriction and placental calcification if prolonged use. Neonatal: Check serum calcium in the newborn if maternal hypercalcemia occurred, particularly if therapy was administered near delivery. |
| Fertility Effects | No specific studies on calcium chloride’s effect on fertility in humans. In animal studies, calcium homeostasis is crucial for reproductive processes; disturbances may impair ovulation and sperm function. In vitro, high extracellular calcium can affect oocyte maturation and sperm motility. Clinically, significant hypercalcemia secondary to excessive calcium administration may disrupt menstrual cycling and ovarian function. However, therapeutic doses used for correction of hypocalcemia are unlikely to affect fertility adversely. |
■ FDA Black Box Warning
Rapid intravenous injection may cause cardiac arrest. Avoid extravasation as it causes severe tissue necrosis. Use with extreme caution in patients receiving digitalis glycosides due to risk of arrhythmias.
| Serious Effects |
HypercalcemiaVentricular fibrillationDigitalis toxicity (risk of arrhythmias)Concurrent use with ceftriaxone in neonates (precipitation risk)
| Precautions | Administer intravenously only; intramuscular or subcutaneous injection causes severe irritation and necrosis., Use with caution in patients with renal impairment, sarcoidosis, or hypercalcemia., Monitor serum calcium levels and electrocardiogram during administration., Risk of bradycardia and arrhythmias, especially with concurrent digitalis therapy., Rapid injection may cause vasodilation, hypotension, and cardiac arrest. |
| Food/Dietary | Avoid excessive intake of oxalate-rich foods (spinach, rhubarb, beets) and phytate-rich foods (bran, whole grains) as they may bind calcium and reduce absorption. Also limit sodium-containing foods to prevent calcium loss via urine. No direct food interactions with intravenous administration. |
| Clinical Pearls | Calcium chloride 10% (100 mg/mL) provides 13.6 mEq/10 mL of calcium. It is highly irritating; administer via central venous line to avoid severe tissue necrosis if extravasation occurs. Do not mix with bicarbonate or phosphate solutions. In cardiac arrest, consider dose of 500-1000 mg IV push (repeat q10min if needed). Contraindicated in digitalis toxicity due to risk of fatal arrhythmias. |
| Patient Advice | This medication is given intravenously to treat calcium deficiency or certain emergencies. · You may experience a warm sensation, metallic taste, or flushing during injection. · Report any burning, pain, or redness at the injection site immediately. · Avoid taking digoxin (digitalis) unless specifically instructed by your doctor. · Do not stop or change the dose without consulting your healthcare provider. |
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