calcium chloride dihydrate: clinical use

Prescribing considerations

• Confirm the indication and assess baseline calcium status, renal function, cardiac history and concurrent medicines.
• Use a secure intravenous route and monitor for extravasation; stop administration at that site immediately if infiltration occurs.
• Calcium chloride is an acidifying salt and is usually undesirable for hypocalcaemia associated with renal insufficiency.
• Check compatibility with intravenous medicines and fluids, particularly ceftriaxone and precipitate-forming anions.
• Calcium chloride and calcium gluconate are not calcium-dose equivalent.

Contraindications and cautions

• Hypersensitivity to calcium chloride or an excipient.
• Conditions associated with hypercalcaemia or hypercalciuria.
• Elevated vitamin D states such as sarcoidosis.
• Current or previous calcium renal calculi.
• Treatment of asystole or electromechanical dissociation.
• Full-term newborns up to 28 days old who require or may require intravenous calcium must not receive ceftriaxone.

Monitoring

• Plasma calcium and other relevant electrolytes.
• Cardiac rhythm and clinical cardiovascular response.
• Blood pressure during administration.
• Intravenous site for pain, swelling, infiltration or tissue injury.
• Renal function and features of hypercalcaemia where clinically relevant.

Clinical pharmacology

Calcium ions support neuromuscular transmission, coagulation and skeletal function. Calcium entry into cardiac muscle promotes actin–myosin interaction and increases myocardial contractility. Calcium is widely distributed, largely stored in bone and partly protein-bound in plasma.

Formulation and product differences

• The selected product is a clear, colourless calcium chloride dihydrate injection supplied in glass ampoules.
• Its excipient is water for injections; hydrochloric acid may be used for pH adjustment.
• Calcium chloride and calcium gluconate preparations must not be assumed to provide equivalent amounts of elemental calcium.