Calcium Salts

In emergency situations wherein there is cardiac toxicity, muscle weakness, or when K+ serum levels is > 6.5 mEq/L, initial therapy should be IV calcium to immediately stabilize the myocardium and protect it against possible arrhythmias due to inconsistent cell polarization. However, IV calcium is not useful to reduce serum K+ levels, so therapies to shift potassium into cells must be carried out such as administration of Insulin and beta-agonists.

A. Calcium Chloride

Mechanism of Action: Antagonizes cardiac conduction abnormalities
Dose: Intravenous, 5-10 mL
Pharmacokinetics:
- Onset of Action: 1-3 mins
- Duration of Effect: 30-50 mins
Contraindications: High risk of arrhythmia for patients taking digoxin
Adverse Effects: Hypercalcemia
Pearls: Has high levels of calcium therefore needs a central line administration; ECG must be done continuously because of the shortlived benefit

B. Calcium Gluconate

Mechanism of Action: Antagonizes cardiac conduction abnormalities
Dose: Intravenous, 10-20 mL
Pharmacokinetics:
- Onset of Action: 1-3 mins
- Duration of Effect: 30-50 mins
Contraindications: High risk of arrhythmia for patients taking digoxin
Adverse Effects: Hypercalcemia
Pearls: Initial dose of 1g IV preferred because of lower risk of tissue necrosis in case of tissue extravasation; safe administration in peripheral vein

Hyperkalemia Pharmacotherapy

Introduction

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Calcium Salts