Calcium

Dosage must be individualized based on the patient's clinical condition and serum calcium levels.

• Hypocalcemic Tetany: Typically 0.5 to 1 gram (5 to 10 mL of a 10% solution) administered intravenously at a slow rate.
• Cardiac Resuscitation: 0.5 to 1 gram intravenously, repeated at 10-minute intervals if necessary.
• Magnesium Toxicity: 500 mg to 1 gram administered intravenously, adjusted based on patient response.

Pediatric dosing is strictly weight-based and must be managed by a specialist.

• Hypocalcemia: 2.7 to 5 mg/kg of elemental calcium administered slowly.
• Cardiac Arrest: 20 mg/kg (0.2 mL/kg of a 10% solution) is sometimes used in specific pediatric advanced life support (PALS) protocols, though its routine use is limited.

Renal Impairment

Patients with chronic kidney disease (CKD) require careful monitoring of the calcium-phosphorus product. Dose reductions may be necessary to prevent soft tissue calcification.

Hepatic Impairment

No specific dose adjustments are generally required for hepatic impairment, as calcium is not metabolized by the liver.

Elderly Patients

Lower initial doses are often recommended due to the increased prevalence of cardiac comorbidities and potential for decreased renal function.

For the chloride form, administration is almost exclusively intravenous. It must be injected slowly (not exceeding 0.5 to 1 mL/min) to prevent high localized concentrations which can cause cardiac arrest. It is ideally administered through a central line to avoid tissue necrosis (death of tissue) associated with extravasation (leaking into surrounding skin).

Since Calcium Chloride is usually administered in a clinical or emergency setting by healthcare professionals, missed doses are rare. If you are taking oral calcium supplements at home, take the missed dose as soon as you remember, unless it is almost time for your next dose. Do not double the dose.

Signs of calcium overdose (hypercalcemia) include lethargy, muscle weakness, nausea, vomiting, and cardiac arrhythmias. In severe cases, it can lead to coma or cardiac arrest. Emergency treatment involves vigorous hydration with normal saline and potentially the use of loop diuretics or bisphosphonates.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance.

Patients receiving Calcium Chloride injections may experience:

• Heat Sensations: A feeling of warmth or 'flushing' throughout the body.
• Chalky Taste: A brief, unusual taste in the mouth following injection.
• Peripheral Vasodilation: A temporary drop in blood pressure as blood vessels relax.

• Nausea and Vomiting: Often related to the speed of administration.
• Local Irritation: Redness or slight pain at the site of the intravenous line.
• Sweating: Clammy skin or increased perspiration.

• Cardiac Arrhythmias: Irregular heartbeats, particularly if the patient is also taking digoxin.
• Hypotension: A significant drop in blood pressure if administered too rapidly.

> Warning: Stop taking Calcium and call your doctor immediately if you experience any of these.

• Extravasation Necrosis: If the medication leaks out of the vein, it can cause severe tissue sloughing and skin death. Seek help if you notice intense pain or blistering at the injection site.
• Severe Hypercalcemia: Symptoms include extreme confusion, bone pain, and severe constipation.
• Anaphylaxis: Signs of a severe allergic reaction such as swelling of the face, hives, or difficulty breathing.
• Bradycardia: An abnormally slow heart rate that may lead to fainting.

Prolonged use or high doses of calcium can lead to the formation of kidney stones (nephrolithiasis) and the calcification of soft tissues, including blood vessels and heart valves. Regular monitoring of blood levels is required for long-term therapy.

No FDA black box warnings are currently issued for Calcium Chloride. However, the FDA emphasizes the extreme risk of tissue necrosis if the drug is not administered strictly into a vein.

Report any unusual symptoms to your healthcare provider.

Calcium Chloride is a potent medication that must be handled with extreme caution. It is significantly more irritating to tissues than calcium gluconate. It should never be injected into the myocardium (heart muscle) or the subarachnoid space.

There are no formal FDA black box warnings for Calcium Chloride, but clinical guidelines treat its administration with the highest level of precaution due to its corrosive nature to tissues.

• Extravasation Risk: This is the most significant risk. If the IV line fails, the drug can cause deep, painful ulcers. Healthcare providers must ensure a secure, patent vein is used.
• Cardiac Irritability: Rapid injection can cause 'calcium shock,' characterized by a sudden drop in blood pressure and heart rhythm disturbances.
• Renal Stones: Patients with a history of kidney stones should use calcium supplements only under strict medical supervision.
• Hypercalcemia Risk: Patients with sarcoidosis or hyperparathyroidism are at a higher risk of developing dangerously high calcium levels.

Patients receiving intravenous calcium require continuous or frequent monitoring of:

• Serum Calcium Levels: To ensure levels remain within the therapeutic range (usually 8.5–10.5 mg/dL).
• ECG (Electrocardiogram): To monitor for heart rhythm changes during administration.
• Renal Function: Monitoring creatinine and BUN levels, especially in long-term use.

Calcium Chloride itself does not typically cause impairment; however, the conditions it treats (like severe hypocalcemia) may cause dizziness or weakness. Do not drive until you know how the treatment affects you.

Alcohol can interfere with calcium absorption and bone metabolism. Chronic alcohol consumption increases the risk of osteoporosis and may complicate the management of calcium levels.

Sudden discontinuation of calcium in patients with chronic hypoparathyroidism can lead to a rapid drop in calcium levels and tetany (muscle spasms). Tapering or transition to oral therapy should be managed by a physician.

> Important: Discuss all your medical conditions with your healthcare provider before starting Calcium.

• Ceftriaxone (in Neonates): The FDA has issued a warning that Ceftriaxone and intravenous calcium must not be administered together in newborns (under 28 days old) due to the risk of fatal precipitates in the lungs and kidneys.
• Digoxin: Calcium increases the risk of digitalis toxicity. Combining the two can lead to fatal heart rhythm disturbances ('stone heart').

• Thiazide Diuretics: Drugs like hydrochlorothiazide reduce the amount of calcium excreted in the urine, increasing the risk of hypercalcemia.
• Tetracycline Antibiotics: Calcium can bind to these drugs in the digestive tract, preventing their absorption and reducing their effectiveness.

• Bisphosphonates: Calcium can interfere with the absorption of these bone-strengthening medications; they should be taken at different times of the day.
• Quinolone Antibiotics: Similar to tetracyclines, calcium can reduce the blood levels of antibiotics like ciprofloxacin.

• Oxalic Acid and Phytic Acid: Found in spinach, rhubarb, and whole grains, these can bind to calcium and prevent its absorption.
• Caffeine: Excessive caffeine can slightly increase calcium excretion in the urine.

• Vitamin D: While necessary for calcium absorption, excessive Vitamin D supplements can lead to hypercalcemia when combined with medicinal calcium.
• Magnesium Supplements: High doses of magnesium may compete with calcium for absorption.

Calcium administration can falsely elevate or depress various lab results, including serum magnesium and phosphate levels. It may also affect the results of certain bone scans.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.

Calcium Chloride must NEVER be used in the following situations:

• Hypercalcemia: Patients who already have high blood calcium levels (e.g., from hyperparathyroidism or certain cancers).
• Ventricular Fibrillation: Unless associated with hyperkalemia, as calcium may worsen the condition.
• Digitalis Toxicity: Due to the extreme risk of inducing fatal arrhythmias.
• Known Hypersensitivity: Any previous severe allergic reaction to calcium chloride or its components.

Healthcare providers will perform a risk-benefit analysis in patients with:

• Renal Impairment: Due to the risk of further kidney damage or stone formation.
• Sarcoidosis: A condition that can increase sensitivity to the effects of calcium.
• Cardiac Disease: Specifically those on heart rhythm medications.

There is no known cross-sensitivity between calcium chloride and unrelated drug classes, but patients sensitive to other calcium salts (like gluconate) should be monitored closely.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Calcium.

Calcium is classified as FDA Pregnancy Category C (older system). While calcium is a normal constituent of human blood and is essential for fetal skeletal development, high doses of intravenous calcium chloride should only be used during pregnancy if clearly needed. According to the American College of Obstetricians and Gynecologists (ACOG), maintaining adequate calcium is vital for preventing preeclampsia, but medical intervention must be carefully titrated.

Calcium is naturally excreted in breast milk. Supplemental calcium is generally considered safe for nursing mothers and may even be necessary to maintain maternal bone density. However, the effects of high-dose intravenous chloride on the nursing infant have not been extensively studied.

Calcium Chloride is used in pediatric emergencies, but it is considered a high-alert medication. It can cause severe damage to small veins. Growth monitoring is generally not required for acute use, but long-term supplementation in children must be supervised by a pediatrician to avoid premature closure of growth plates.

Older adults are at higher risk for hypercalcemia and kidney stones. Furthermore, many seniors take digoxin or thiazide diuretics, which significantly increases the risk of dangerous drug interactions. Renal function (GFR) should be assessed before initiating therapy.

In patients with a GFR below 30 mL/min, calcium must be used with extreme caution. These patients often have high phosphate levels; adding calcium can lead to the formation of calcium-phosphate crystals in the blood vessels.

No specific adjustments are needed for patients with liver disease, though these patients often have low albumin levels, which can make 'total calcium' lab results misleading. 'Ionized calcium' levels should be monitored instead.

> Important: Special populations require individualized medical assessment.

Calcium Chloride acts as an exogenous source of calcium ions. These ions are vital for the 'all-or-none' response of nerve fibers and the contraction of all muscle types. In the cardiac muscle, calcium facilitates the interaction between actin and myosin filaments. It also acts as an acidifying agent by releasing chloride ions, which can help correct certain types of metabolic alkalosis.

The onset of action for intravenous Calcium Chloride is immediate. The duration of effect depends on the patient's underlying calcium status and renal function, typically lasting from 30 minutes to 2 hours. It does not typically lead to tolerance, but the body's homeostatic mechanisms (PTH and Vitamin D) will work to normalize levels quickly.

| Parameter | Value |

|---|---|

| Bioavailability | 100% (IV) |

| Protein Binding | ~40% (to Albumin) |

| Half-life | Variable (Homeostatically regulated) |

| Tmax | Immediate (IV) |

| Metabolism | None (Elemental) |

| Excretion | Renal (20%), Fecal (80%) |

• Molecular Formula: $CaCl_2$
• Molecular Weight: 110.98 g/mol
• Solubility: Highly soluble in water.
• Structure: An inorganic salt consisting of one calcium cation and two chloride anions.

Calcium Chloride is categorized as an electrolyte and a mineral supplement. It is closely related to Calcium Gluconate and Calcium Carbonate, though it is more potent and irritating than other forms.