Indications
Calcium chloride dihydrate is a source of calcium used mainly as an ingredient in dialysis solutions (haemodialysis concentrates and peritoneal dialysis fluids), where it keeps blood calcium at the right level during treatment. It is also used in some intravenous fluids, and as a separate injection in hospitals to treat severely low blood calcium, very high blood potassium affecting the heart, and some cases of calcium channel blocker or magnesium poisoning.
How It Works
Calcium is needed for nerve signals, muscle contraction (including the heart) and blood clotting. In dialysis fluid, calcium chloride sets the calcium concentration so that calcium moves into or out of the blood in a controlled way. Given into a vein, it quickly raises blood calcium and stabilises the heart muscle.
Dosage and Administration
Dialysis solutions are prepared and used by trained dialysis staff according to the prescription set by the kidney specialist. Calcium chloride injections are given slowly into a vein by a doctor or nurse, with heart monitoring. It is never injected into a muscle or under the skin because it severely irritates tissues.
Interactions
- Digoxin: raised calcium increases the risk of dangerous heart rhythms.
- Thiazide diuretics such as Hydrochlorothiazide can raise calcium further.
- It must not be mixed in the same line with Sodium Bicarbonate or phosphate solutions, which form deposits, or with Ceftriaxone.
- It can reduce the effect of calcium channel blockers such as Verapamil.
Contraindications
- High blood calcium (hypercalcaemia) or high urine calcium.
- Ventricular fibrillation or digoxin toxicity, unless directed by a specialist.
Side Effects
During dialysis, an unsuitable calcium level can cause muscle cramps, low or high blood pressure, or tingling. With injections: warmth or a chalky taste, tingling, flushing, low blood pressure, slow heartbeat, and burning or tissue damage if it leaks out of the vein.
Tell the staff at once, or get urgent medical help, for chest pain, palpitations or an irregular heartbeat, fainting, severe pain or swelling at the injection site, confusion, or severe muscle weakness.
Pregnancy and Lactation
Dialysis and treatment of serious calcium or potassium problems are continued in pregnancy and breastfeeding when the doctor considers them necessary. Calcium is a normal part of breast milk.
Precautions and Warnings
- Blood calcium, potassium, phosphate and magnesium are checked regularly.
- Use with care in kidney disease, heart disease, sarcoidosis and in patients taking Digoxin.
- Dialysis concentrates are not for direct injection or drinking.
Overdose
Too much calcium causes nausea, vomiting, weakness, confusion, heart rhythm problems and, in severe cases, coma. The medical team stops the calcium and treats the high level.
Therapeutic Class
Electrolyte replenisher (calcium salt); dialysis solution component.
Storage
Hospital and dialysis products: store as directed on the pack, generally below 30°C. Do not freeze. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.