Note: 1 g of calcium chloride salt is equal to 273 mg of elemental calcium.
Daily maintenance calcium: Dosage expressed in terms of elemental calcium: IV: 3 to 4 mEq/kg/day.
Parenteral nutrition, maintenance calcium requirement (ASPEN [Mirtallo 2004]): Dosage expressed in terms of elemental calcium: IV: 2 to 4 mEq/kg/day as an additive to parenteral nutrition solution.
Hypocalcemia: Dosage expressed in mg of calcium chloride: IV: 10 to 20 mg/kg/dose, repeat every 4 to 6 hours if needed.
Cardiac arrest in the presence of hyperkalemia or hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity: Dosage expressed in mg of calcium chloride: IV, Intraosseous: 20 mg/kg; may repeat in 10 minutes if necessary; if effective, consider IV infusion of 20 to 50 mg/kg/hour.
Tetany: Dosage expressed in mg of calcium chloride: IV: 10 mg/kg over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 200 mg/kg/day.
Note: 1 g of calcium chloride salt is equal to 273 mg of elemental calcium.
Daily maintenance calcium: Dosage expressed in terms of elemental calcium.
Infants and Children <25 kg: IV: 1 to 2 mEq/kg/day.
Children 25 to 45 kg: IV: 0.5 to 1.5 mEq/kg/day.
Children >45 kg and Adolescents: IV: 0.2 to 0.3 mEq/kg/day or 10 to 20 mEq/day.
Parenteral nutrition, maintenance calcium requirement (ASPEN [Mirtallo 2004]): Note: Dosage expressed in terms of elemental calcium.
Infants and Children ≤50 kg: IV: 0.5 to 4 mEq/kg/day as an additive to parenteral nutrition solution.
Children >50 kg and Adolescents: IV: 10 to 20 mEq/day as an additive to parenteral nutrition solution.
Hypocalcemia: Note: In general, IV calcium gluconate is preferred over IV calcium chloride in nonemergency settings due to the potential for extravasation with calcium chloride. Dosage expressed in mg of calcium chloride.
Infants, Children, and Adolescents:
Manufacturer's recommendations: IV: 2.7 to 5 mg/kg/dose every 4 to 6 hours; maximum dose: 1,000 mg.
Alternative dosing: IV: 10 to 20 mg/kg/dose; maximum dose: 1,000 mg; repeat every 4 to 6 hours if needed.
Cardiac arrest in the presence of hyperkalemia or hypocalcemia, hypermagnesemia, or calcium channel antagonist toxicity (PALS recommendations): Infants, Children, and Adolescents: Dosage expressed in mg of calcium chloride: IV, Intraosseous: 20 mg/kg/dose (maximum dose: 2,000 mg); may repeat in 10 minutes if necessary; if effective, consider IV infusion of 20 to 50 mg/kg/hour; Note: Routine use in cardiac arrest is not recommended due to the lack of improved survival (Hegenbarth 2008; Kleinman 2010).
Calcium channel blocker toxicity: Infants, Children, and Adolescents: Dosage expressed in mg of calcium chloride: IV: 20 mg/kg/dose infused over 5 to 10 minutes; if effective, consider IV infusion of 20 to 50 mg/kg/hour (Kleinman 2010).
Hypocalcemia secondary to citrated blood infusion: Infants, Children, and Adolescents: IV: 0.45 mEq elemental calcium for each 100 mL citrated blood infused.
Tetany: Infants, Children, and Adolescents: Dosage expressed in mg of calcium chloride: IV: 10 mg/kg over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 200 mg/kg/day.
No initial dosage adjustment necessary; however, accumulation may occur with renal impairment and subsequent doses may require adjustment based on serum calcium concentrations.
No initial dosage adjustment necessary; subsequent doses should be guided by serum calcium concentrations.
(For additional information see "Calcium chloride: Drug information")
Note: One gram of calcium chloride salt is equal to 270 mg of elemental calcium.
Dosages are expressed in terms of the calcium chloride salt based on a solution concentration of 100 mg/mL (10%) containing 1.4 mEq (27 mg)/mL elemental calcium.
Beta-blocker overdose (off-label use): Based on limited data: IV: Initial: Using a 10% solution: 20 mg/kg over 5 to 10 minutes (maximum: 1 to 2 g/dose); may repeat every 10 to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion of 20 to 40 mg/kg/hour titrated to improve hemodynamic response (AHA [Panchal 2020]; DeWitt 2004; Kerns 2007).
Calcium channel blocker overdose (off-label use): Based on limited data: IV: Initial: Using a 10% solution: 20 mg/kg over 5 to 10 minutes (maximum: 1 to 2 g/dose); may repeat every 10 to 20 minutes for 3 to 4 additional doses or initiate a continuous infusion of 20 to 40 mg/kg/hour titrated to improve hemodynamic response (ACC/AHA/HRS [Kusumoto 2019]; AHA [Panchal 2020]; DeWitt 2004; Kerns 2007; St-Onge 2017). Note: Some recommend maintaining serum ionized calcium at a goal of twice normal (Kerns 2007).
Cardiac arrest or cardiotoxicity in the presence of hypocalcemia or hypermagnesemia (off-label use): IV, Intraosseous: 500 to 1,000 mg over 2 to 5 minutes; may repeat as necessary (AHA [Panchal 2020])
Note: Routine use in cardiac arrest is not recommended due to the lack of improved survival (AHA [Panchal 2020]).
Hydrofluoric acid exposure (off-label use): Note: Consultation with a clinical toxicology or poison control center is recommended prior to the use of calcium chloride for hydrofluoric acid exposure.
Systemic toxicity: Note: Calcium chloride has been used in the treatment of systemic toxicity secondary to hydrofluoric acid exposure (Greco 1988; Vohra 2008; Wu 2010); however, calcium gluconate may be preferred due to the potential for more severe extravasation with calcium chloride.
IV: Exact dose has not been established; clinicians should tailor dose based on patient-specific needs (Wu 2010). Bolus doses of up to 4 g have been required (Wu 2010); repeat as needed based on symptoms of toxicity (eg, cardiac arrhythmias) and serum calcium concentration.
Hydrofluoric acid burns (severe): Intra-arterial: 10% solution: Add 10 mL of a 10% solution in 40 to 50 mL of D5W; infuse over 4 hours into the artery that provides the vascular supply to the affected area. Pain usually resolves by the end of the infusion; repeat if pain recurs (Vance 1986). This intervention should be used only by those accustomed to this technique. Care should be taken to avoid the extravasation. A poison information center or clinical toxicologist should be consulted prior to implementation.
Hyperkalemia , severe/emergent (off-label use): Note: Use in patients with hyperkalemia-associated ECG changes or serum potassium >6.5 mEq/L (KDIGO [Clase 2020]). Stabilizes myocardial cell membrane without impacting plasma potassium concentrations; must combine with insulin/dextrose to decrease plasma potassium levels and other therapies to eliminate potassium from body (AHA [Panchal 2020]). Perform continuous cardiac monitoring and obtain serial ECGs (KDIGO [Clase 2020]).
IV, Intraosseous: Initial: 0.5 to 1 g over 2 to 5 minutes; may repeat after 5 minutes if ECG changes persist or recur, then every 30 to 60 minutes as needed (AHA [Panchal 2020]; Mount 2021).
Hypocalcemia:
Acute, symptomatic: Manufacturer's labeling: IV: 200 to 1,000 mg every 1 to 3 days
Severe, symptomatic (eg, seizure, tetany): IV: 1,000 mg over 10 minutes; repeat every 60 minutes until symptoms resolve (French 2012)
Note: In general, IV calcium gluconate is preferred over IV calcium chloride in nonemergency settings due to the potential for more severe extravasation with calcium chloride.
No initial dosage adjustment necessary; however, accumulation may occur with renal impairment and subsequent doses may require adjustment based on serum calcium concentrations.
No initial dosage adjustment necessary; subsequent doses should be guided by serum calcium concentrations.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 10% (10 mL)
Solution, Intravenous [preservative free]:
Generic: 10% (10 mL)
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Calciject: 10% (10 mL, 50 mL)
Generic: 10% (10 mL)
1 g calcium chloride = elemental calcium 273 mg = calcium 13.6 mEq = calcium 6.8 mmol
Parenteral: Do not use scalp vein or small hand or foot veins for IV administration; central-line administration is the preferred route. Not for endotracheal administration. Do not inject calcium salts IM or administer SubQ since severe necrosis and sloughing may occur; extravasation of calcium can result in severe necrosis and tissue sloughing. Stop the infusion if the patient complains of pain or discomfort. Warm solution to body temperature prior to administration. Do not infuse calcium chloride in the same IV line as phosphate-containing solutions.
IV: For direct IV injection infuse slow IVP over 3 to 5 minutes or at a maximum rate of 50 to 100 mg calcium chloride/minute; in situations of cardiac arrest, calcium chloride may be administered over 10 to 20 seconds.
IV infusion: Further dilute and administer 45 to 90 mg calcium chloride/kg over 1 hour; 0.6 to 1.2 mEq calcium/kg over 1 hour
Parenteral nutrition solution: Although calcium chloride is not routinely used in the preparation of parenteral nutrition, it is important to note that calcium-phosphate stability in parenteral nutrition solutions is dependent upon the pH of the solution, temperature, and relative concentration of each ion. The pH of the solution is primarily dependent upon the amino acid concentration. The higher the percentage amino acids, the lower the pH and the more soluble the calcium and phosphate. Individual commercially available amino acid solutions vary significantly with respect to pH lowering potential and consequent calcium phosphate compatibility; consult product specific labeling for additional information.
Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Early/acute calcium extravasation: If acute extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see Management of Drug Extravasations for more details); remove needle/cannula; apply dry cold compresses; elevate extremity (Hurst 2004; Reynolds 2014).
Delayed calcium extravasation: If delayed extravasation suspected, closely monitor site; most calcifications spontaneously resolve. However, if a severe manifestation of calcinosis cutis occurs, may initiate sodium thiosulfate antidote (See Management of Drug Extravasations for more details) (Reynolds 2014).
IV: For IV administration only. Not for IM or SUBQ administration (severe necrosis and sloughing may occur). Avoid rapid administration (do not exceed 100 mg/minute except in emergency situations). For intermittent IV infusion, infuse diluted solution over 1 hour or no greater than 45 to 90 mg/kg/hour (0.6 to 1.2 mEq/kg/hour); administration via a central or deep vein is preferred; do not use small hand or foot veins for IV administration (severe necrosis and sloughing may occur). Typical rates of administration may vary with indication; refer to institutional protocol. Monitor ECG if calcium is infused faster than 2.5 mEq/minute; stop the infusion if the patient complains of pain or discomfort. Warm solution to body temperature prior to administration. Do not infuse calcium chloride in the same IV line as phosphate-containing solutions.
Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line).
Early/acute calcium extravasation: Initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses; elevate extremity (Hurst 2004; Reynolds 2014).
Hyaluronidase: Intradermal or SUBQ: Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (MacCara 1983; Reynolds 2014; Zenk 1981). May also inject hyaluronidase through the catheter that caused the infiltration (Reynolds 2014).
Delayed calcium extravasation: Closely monitor site; most calcifications spontaneously resolve. However, if a severe manifestation of calcinosis cutis occurs, may initiate sodium thiosulfate antidote.
Sodium thiosulfate: IV: 12.5 g over 30 minutes; may increase gradually to 25 g 3 times per week; monitor for non-anion gap acidosis, hypocalcemia, severe nausea (Reynolds 2014).
Store intact vials at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Do not refrigerate solutions; IV infusion solutions in D5W, LR, NS, or other appropriate solutions are stable for 24 hours at room temperature.
Although calcium chloride is not routinely used in the preparation of parenteral nutrition, it is important to note that phosphate salts may precipitate when mixed with calcium salts. Solubility is improved in amino acid parenteral nutrition solutions. Check with a pharmacist to determine compatibility.
Treatment of hypocalcemia and conditions secondary to hypocalcemia (eg, tetany, seizures, arrhythmias); treatment of cardiac disturbances secondary to hyperkalemia; adjunctive treatment of magnesium sulfate overdose [All indications: FDA approved in pediatric patients (age not specified) and adults]; has also been used for calcium channel blocker toxicity, or beta-blocker toxicity refractory to glucagon and vasopressors
Calcium chloride may be confused with calcium gluconate
Calcium chloride may be confused with calcium gluconate.
Confusion with the different intravenous salt forms of calcium has occurred. There is a threefold difference in the primary cation concentration between calcium chloride (in which 1 g = 14 mEq [270 mg] of elemental Ca++) and calcium gluconate (in which 1 g = 4.65 mEq [90 mg] of elemental Ca++).
Prescribers should specify which salt form is desired. Dosages should be expressed either as mEq, mg, or grams of the salt form.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined. IV:
Cardiovascular (following rapid IV injection): Bradycardia, cardiac arrest, cardiac arrhythmia, hypotension, syncope, vasodilation
Central nervous system: Feeling abnormal (sense of oppression; with rapid IV injection), tingling sensation (with rapid IV injection)
Endocrine & metabolic: Hot flash (with rapid IV injection), hypercalcemia
Gastrointestinal: Dysgeusia (chalky taste), gastrointestinal irritation, increased serum amylase
Local: Local tissue necrosis (following extravasation)
Renal: Nephrolithiasis
Postmarketing and/or case reports: Cutaneous calcification
Not recommended as routine treatment in cardiac arrest (includes asystole, ventricular fibrillation, pulseless ventricular tachycardia, or pulseless electrical activity)
Concerns related to adverse effects:
• Extravasation: Vesicant; ensure proper catheter or needle position prior to and during infusion. Avoid extravasation. Extravasation may result in severe necrosis and sloughing. Monitor the IV site closely.
Disease-related concerns:
• Acidosis: Use with caution in patients with respiratory acidosis, renal impairment, or respiratory failure; acidifying effect of calcium chloride may potentiate acidosis.
• Hyperphosphatemia: Use with caution in patients with severe hyperphosphatemia as elevated levels of phosphorus and calcium may result in soft tissue and pulmonary arterial calcium-phosphate precipitation.
• Hypokalemia: Use with caution in patients with severe hypokalemia as acute rises in serum calcium levels may result in life-threatening cardiac arrhythmias.
• Hypomagnesemia: Hypomagnesemia is a common cause of hypocalcemia; therefore, correction of hypocalcemia may be difficult in patients with concomitant hypomagnesemia. Evaluate serum magnesium and correct hypomagnesemia (if necessary), particularly if initial treatment of hypocalcemia is refractory.
• Renal impairment: Use with caution in patients with chronic renal failure to avoid hypercalcemia; frequent monitoring of serum calcium and phosphorus is necessary.
Concurrent drug therapy issues:
• Ceftriaxone: Ceftriaxone may complex with calcium causing precipitation. Fatal lung and kidney damage associated with calcium-ceftriaxone precipitates has been observed in premature and term neonates. Due to reports of precipitation reaction in neonates, do not coadminister ceftriaxone with calcium-containing solutions, even via separate infusion lines/sites or at different times in any neonate. Ceftriaxone should not be administered simultaneously with any calcium-containing solution via a Y-site in any patient. However, ceftriaxone and calcium-containing solutions may be administered sequentially of one another for use in patients other than neonates if infusion lines are thoroughly flushed (with a compatible fluid) between infusions.
• Digoxin: Use with caution in digitalized patients; hypercalcemia may precipitate cardiac arrhythmias; use is contraindicated with known or suspected digoxin toxicity.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.
Other warnings/precautions:
• Appropriate product selection: Multiple salt forms of calcium exist; close attention must be paid to the salt form when ordering and administering calcium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over or under dosing.
• Duration of use: Avoid metabolic acidosis (ie, administer only up to 2 to 3 days then change to another calcium salt).
• IV administration: For IV use only; do not inject SUBQ or IM Avoid too rapid IV administration (do not exceed 100 mg/minute except in emergency situations).
None known.
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Calcium Salts may decrease the serum concentration of Bictegravir. Management: Bictegravir, emtricitabine, and tenofovir alafenamide can be administered with calcium salts under fed conditions, but coadministration with or 2 hours after a calcium salt is not recommended under fasting conditions. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Risk X: Avoid combination
Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cardiac Glycosides: Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy
CefTRIAXone: Calcium Salts (Intravenous) may enhance the adverse/toxic effect of CefTRIAXone. Ceftriaxone binds to calcium forming an insoluble precipitate. Management: Use of ceftriaxone is contraindicated in neonates (28 days of age or younger) who require (or are expected to require) treatment with IV calcium-containing solutions. In older patients, flush lines with compatible fluid between administration. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy
Dolutegravir: Calcium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral calcium. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral calcium salts. Alternatively, dolutegravir and oral calcium can be taken together with food. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
Multivitamins/Fluoride (with ADE): May increase the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). More specifically, calcium salts may impair the absorption of fluoride. Management: Avoid eating or drinking dairy products or consuming vitamins or supplements with calcium salts one hour before or after of the administration of fluoride. Risk D: Consider therapy modification
Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of Calcium Salts. Risk C: Monitor therapy
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Phosphate Supplements: Calcium Salts may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Risk D: Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Risk D: Consider therapy modification
Tetracyclines: Calcium Salts may decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines cannot be avoided, consider separating administration of each agent by several hours. Risk D: Consider therapy modification
Thiazide and Thiazide-Like Diuretics: May decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy
Thyroid Products: Calcium Salts may diminish the therapeutic effect of Thyroid Products. Management: Separate the doses of the thyroid product and the oral calcium supplement by at least 4 hours. Monitor for decreased therapeutic effects of thyroid products if an oral calcium supplement is initiated/dose increased. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Risk D: Consider therapy modification
Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Risk C: Monitor therapy
Calcium crosses the placenta. The amount of calcium reaching the fetus is determined by maternal physiological changes. Calcium requirements are the same in pregnant and nonpregnant females (IOM 2011).
Information related to use as an antidote in pregnancy is limited. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the nonpregnant woman. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (Jeejeebhoy [AHA] 2015).
Serum calcium (ionized calcium preferred if available), phosphate, magnesium, heart rate, ECG
|
Age |
Normal Values Serum Concentration | |
|---|---|---|
|
Calcium, total |
Cord blood |
9-11.5 mg/dL |
|
Newborn 3-24 hours |
9-10.6 mg/dL | |
|
Newborn 24-48 hours |
7-12 mg/dL | |
|
4-7 days |
9-10.9 mg/dL | |
|
Child |
8.8-10.8 mg/dL | |
|
Adolescent to Adult |
8.4-10.2 mg/dL | |
|
Calcium, ionized, whole blood |
Cord blood |
5-6 mg/dL |
|
Newborn 3-24 hours |
4.3-5.1 mg/dL | |
|
Newborn 24-48 hours |
4-4.7 mg/dL | |
|
≥2 days |
4.8-4.92 mg/dL (2.24-2.46 mEq/L) |
Moderates nerve and muscle performance via action potential excitation threshold regulation
Protein binding: ~40%, primarily to albumin (Wills 1971).
Excretion: Primarily feces (80% as insoluble calcium salts); urine (20%).
Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended. If ionized calcium is unavailable, in low albumin states, the corrected total serum calcium may be estimated by this equation (assuming a normal albumin of 4 g/dL); [(4 – patient's albumin) x 0.8] + patient's measured total calcium
|
Calcium Salt |
Elemental Calcium (mg/1 g of salt form) |
Calcium (mEq/g) |
|---|---|---|
|
Calcium acetate |
253 |
12.7 |
|
Calcium carbonate |
400 |
20 |
|
Calcium chloride |
273 |
13.6 |
|
Calcium citrate |
211 |
10.5 |
|
Calcium glubionate |
63.8 |
3.2 |
|
Calcium gluconate |
93 |
4.65 |
|
Calcium lactate |
130 |
6.5 |
|
Calcium phosphate (tribasic) |
390 |
19.3 |
Solution (Calcium Chloride Intravenous)
10% (per mL): $0.89 - $2.43
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