Calcium Chloride (Calcium Chloride)

Anesthesia Implications

Classification: Electrolyte supplement and positive inotrope.
Therapeutic Effects: Electrolyte replacement and positive inotrope. Treatment of hyperkalemia (with ECG changes), hypermagnesemia, and calcium antagonist overdose.
Time to Onset: <30 seconds for electrolyte replacement and inotropic effects.
Time to Peak: <1 minute.
Duration: 10-20 minutes for inotropic effects.

Contraindications

Hypercalcemia
Digitalis toxicity (risk of arrhythmias)
Parenteral admixture incompatibility (e.g., carbonates, phosphates, sulfates)

Primary Considerations

Essential Electrolyte – An increase in myocardial contractility elevates cardiac output, whereas a decrease in peripheral vascular resistance is linked to a reduced heart rate. Calcium is essential for these cardiovascular functions, playing a vital role in the contraction of cardiac, smooth, and skeletal muscles. It is also crucial for maintaining the functional integrity of the nervous, muscular, and skeletal systems, as well as for cell membrane and capillary permeability. Additionally, calcium is important for renal function, respiration, and blood clotting.

Avoid Rapid Injection – this can cause arrhythmias, hypotension, or hypertension.

Extravasation Risk – Use the IV route only; extravasation can cause necrosis or sloughing. Treat with 1% procaine hydrochloride and hyaluronidase if extravasation occurs.

Hypercalcemia –  More dangerous than hypocalcemia.  Monitor serum calcium levels and ECG to prevent complications like arrhythmias, coma, or sudden death.

Acidifying Effects – Avoid in cases of concurrent acidosis and hypocalcemia.

Transfusion Monitoring – Administer calcium during rapid transfusions of citrated blood (>2ml/kg/min) to prevent hypocalcemia.  Hypocalcemia can also be caused by large volumes of colloid solutions. 

IV push dose

Adults – IV 500-1000 mg; Give no faster than 1.0 ml/minute (2% – 10% solution)

Peds: IV 10-25 mg/kg; Give over 5-10 minutes (2% – 10% solution)

Maintain serum calcium 8.5 – 10.0 mg/dL

Reversal

No direct reversal; effects are managed through saline infusions and IV diuretics (e.g., furosemide) in cases of hypercalcemia.

Method of Action

Calcium plays a critical role in various physiological processes, including muscle contraction, nerve impulse transmission, blood coagulation, and bone formation. It acts as a secondary messenger in cell signaling, regulates neurotransmitter release, and stabilizes cell membranes. Calcium is essential for enzyme activity and supports bone remodeling through its role in hydroxyapatite formation. Its tightly regulated levels ensure proper function in the cardiovascular, nervous, and skeletal systems.

Metabolism

Not metabolized.

Elimination

GI and renal pathways.