Calcium Infusion Guidelines

Indications and Administration

Early neonatal hypocalcemia due to interruption of placental transfer and relative immaturity of hormonal control may be treated with calcium infusion 1
Calcium channel blocker toxicity with hemodynamic instability may be treated with calcium infusion, with a recommended dose of 20 mg/kg (0.2 mL/kg) of 10% calcium chloride intravenously over 5-10 minutes 2, 3
Beta-blocker overdose with shock refractory to other measures may be treated with calcium infusion, with a recommended dose of 0.3 mEq/kg of calcium (0.6 mL/kg of 10% calcium gluconate or 0.2 mL/kg of 10% calcium chloride) IV over 5-10 minutes 4, 5
Hypermagnesemia with cardiotoxicity or cardiac arrest may be treated with calcium infusion, with a recommended dose of 5-10 mL of 10% calcium chloride or 15-30 mL of 10% calcium gluconate IV over 2-5 minutes 6
Hyperkalemia with cardiac manifestations may be treated with calcium infusion 3

Serum ionized calcium concentration should be monitored to prevent hypercalcemia during calcium infusion 2, 7
Heart rate should be monitored during administration, and the injection should be stopped if symptomatic bradycardia occurs 3
Calcium infusion should not be mixed with sodium bicarbonate or vasoactive amines 3
Calcium chloride provides a more rapid increase in ionized calcium than calcium gluconate and is preferred for critically ill patients 3

In pediatric patients with calcium channel blocker toxicity, calcium infusion is recommended as part of the treatment protocol 2, 7
During massive transfusion, calcium should be administered if ionized calcium levels are low or if ECG changes suggest hypocalcemia 8