Calcium Chloride Use in Pediatric Patients

Indications and Contraindications

The American Heart Association recommends against the routine use of calcium chloride in pediatric cardiac arrest, except in specific life-threatening conditions such as documented hypocalcemia, hyperkalemia, hypermagnesemia, and calcium channel blocker toxicity 1, 2, 3, 4
Routine administration of calcium during pediatric cardiopulmonary arrest is not recommended and may cause harm, with a Class III: Harm recommendation and B-NR level of evidence 1, 2, 3, 4

For symptomatic hyperkalemia with ECG changes, the American Academy of Pediatrics recommends giving 100-200 mg/kg/dose of calcium chloride via slow infusion with continuous ECG monitoring 9
The American Academy of Pediatrics suggests administering 20 mg/kg (0.2 mL/kg of 10% calcium chloride) IV/IO by slow push during cardiac arrest for life-threatening hyperkalemia, hypermagnesemia, and calcium channel blocker toxicity 6, 7, 8
For non-arrest calcium channel blocker poisoning, the American Heart Association recommends infusing calcium chloride over 5-10 minutes, followed by continuous infusion of 20-50 mg/kg per hour 12

The American Academy of Pediatrics prefers central venous catheter administration of calcium chloride and recommends continuous ECG monitoring during administration 6, 7, 8
The American Heart Association advises against administering calcium and sodium bicarbonate through the same IV line due to the risk of precipitation 6, 7, 8, 9, 10

The American Academy of Pediatrics warns against confusing calcium chloride with calcium gluconate dosing, as they are not equivalent on a mg-per-mg basis 6, 7, 8
The Journal of Clinical Oncology recommends considering renal consultation before calcium administration in tumor lysis syndrome with hyperphosphatemia to avoid calcium phosphate precipitation and obstructive uropathy 9, 10