CALCIUM CHLORIDE 10% IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for CALCIUM CHLORIDE 10% IN PLASTIC CONTAINER (CALCIUM CHLORIDE 10% IN PLASTIC CONTAINER).
Calcium ion is essential for normal cell function, including muscle contraction, nerve transmission, and blood coagulation. It acts as a positive inotrope by increasing myocardial contractility and also corrects hypocalcemia.
| Metabolism | Calcium chloride dissociates to release calcium ions which are primarily regulated by the kidney; no significant hepatic metabolism. |
| Excretion | Primarily renal (80-90% as ionized calcium); minor fecal elimination (<10%). |
| Half-life | 2-4 hours in patients with normal renal function; prolonged in renal impairment. |
| Protein binding | Approximately 45-50% bound primarily to albumin. |
| Volume of Distribution | 0.5-0.6 L/kg; primarily distributed in extracellular fluid. |
| Bioavailability | Not applicable; administered only intravenously. Oral calcium salts have variable bioavailability (25-40%). |
| Onset of Action | Intravenous: immediate (seconds to 1 minute). |
| Duration of Action | Intravenous: 30 minutes to 2 hours; effect limited by rapid redistribution and renal excretion. |
| 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 as needed based on serum calcium levels and clinical response.
| Dosage form | INJECTABLE |
| Renal impairment | GFR 30-60 mL/min: Use with caution; monitor serum calcium and phosphate levels. GFR <30 mL/min: Avoid use or use only if benefit outweighs risk; reduce dose by 50% and monitor serum calcium and phosphate closely. |
| Liver impairment | No dose adjustment recommended for Child-Pugh Class A or B. Child-Pugh Class C: Use with caution; monitor serum calcium and cardiac function due to potential for accumulation of calcium and effects on myocardial contractility. |
| Pediatric use | IV: 0.2 mL/kg (20 mg/kg) of 10% solution, administered slowly at a rate not exceeding 0.5-1 mL/min. Dose may be repeated if needed. Maximum single dose: 1 g (10 mL). |
| Geriatric use | No specific dose adjustment, but consider reduced renal function common in elderly; use lowest effective dose and monitor serum calcium, phosphate, and cardiac status. Infusion rate should be slow (0.5-1 mL/min) to avoid adverse effects. |
| 1st trimester | Calcium is essential for fetal development; administration is safe and often recommended for maternal hypocalcemia. No teratogenic effects reported at therapeutic doses. |
| 2nd trimester | Safe for use; monitor serum calcium to avoid hypercalcemia, which may cause fetal bradycardia or hypoparathyroidism. |
| 3rd trimester | Safe but avoid excessive doses; hypercalcemia can suppress fetal parathyroid function and leading to neonatal hypocalcemia. |
Clinical note
Comprehensive clinical and safety monograph for CALCIUM CHLORIDE 10% IN PLASTIC CONTAINER (CALCIUM CHLORIDE 10% IN PLASTIC CONTAINER).
| Placental transfer | Calcium crosses the placenta by active transport, maintaining fetal calcium homeostasis. Transfer is regulated and increases with maternal hypocalcemia or high doses. |
| Breastfeeding | Calcium is excreted into breast milk in small amounts and is considered compatible with breastfeeding. Normal physiological levels are not a concern; monitor maternal serum calcium if using high doses. |
| Lactation Rating | L1 (Compatible) |
| Teratogenic Risk | No evidence of teratogenicity in animal studies; calcium chloride is a normal blood constituent. First trimester: no known risk. Second and third trimesters: use only if clearly needed; high doses may cause hypercalcemia in fetus (e.g., hypotonia, poor feeding). Intravenous administration near term may suppress fetal parathyroid function. |
| Fetal Monitoring | Monitor serum ionized calcium, magnesium, and phosphate levels; assess maternal ECG for arrhythmias if rapid IV administration. Fetal monitoring for signs of hypercalcemia (e.g., bradycardia, polyhydramnios) only in prolonged high-dose exposure. Avoid extravasation (tissue necrosis). |
| Fertility Effects | No known effect on fertility or reproductive performance in humans. |
■ FDA Black Box Warning
Do not administer by intracardiac injection due to risk of myocardial rupture and cardiac arrest.
| Serious Effects |
HypercalcemiaSevere renal impairmentVentricular fibrillation during cardiopulmonary resuscitation
| Precautions | Extravasation can cause tissue necrosis; administer slowly to avoid hypercalcemia; use with caution in digitalis toxicity as hypercalcemia potentiates digoxin toxicity; monitor serum calcium levels; avoid in patients with renal failure unless severe hypocalcemia exists. |
| Food/Dietary | Avoid calcium-fortified foods and dairy products if serum calcium is elevated. High doses of vitamin D can increase calcium absorption, leading to hypercalcemia. Caffeine and alcohol may increase urinary calcium excretion, potentially reducing efficacy. Oxalate-rich foods (spinach, rhubarb) and phytate-rich foods (whole grains) bind calcium and may reduce absorption, but this is less relevant with IV administration. |
| Clinical Pearls | Calcium chloride provides approximately 3 times more elemental calcium per mL than calcium gluconate. Due to its high osmolality (approx. 2000 mOsm/L), it is a severe vesicant; central line administration is strongly preferred to prevent tissue necrosis if extravasation occurs. For peripheral IV, use a large bore vein with good blood flow and avoid hand/wrist veins. In cardiac arrest (e.g., hyperkalemia, calcium channel blocker overdose), give 10 mL of 10% solution (1 g) IV push; may repeat every 10 minutes if needed. Monitor serum calcium, magnesium, and phosphate levels; correct hypomagnesemia before calcium therapy to prevent refractory hypocalcemia. Contraindicated in digitalis toxicity (can precipitate fatal arrhythmias). Not for IM or SC use. |
| Patient Advice | Report any burning, pain, or swelling at the IV site immediately. · This medication increases calcium levels; do not take additional calcium supplements or antacids without doctor approval. · Calcium can interfere with the absorption of certain antibiotics (tetracyclines, fluoroquinolones) and thyroid medications; separate doses by at least 2-4 hours. · Avoid excessive intake of vitamin D or calcium-rich foods unless directed by your doctor. · Seek emergency care if you experience chest pain, irregular heartbeat, or muscle cramps. |
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