Calcium chloride

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Calcium chloride
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

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Overview

Calcium chloride is a mineral that is FDA approved for the treatment of hypocalcemia, lead colic, magnesium intoxication, hyperkalemia,. Common adverse reactions include tingling sensations, calcium taste, a sense of oppression or “heat wave, peripheral vasodilation, local “burning” sensation, hypotention.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Indications

  • Calcium Chloride Injection, USP, 10% is indicated:
  • As adjunctive therapy in the management of acute symptoms in lead colic.
  • In the treatment of magnesium intoxication due to overdosage of magnesium sulfate.
  • In severe hyperkalemia, to combat deleterious effects on electrocardiographic (ECG) function, pending correction of the potassium level in the extracellular fluid.
  • In cardiac resuscitation, particularly after open heart surgery, when epinephrine fails to improve weak or ineffective myocardial contractions.

Dosing

INTRACARDIAC USE

  • For cardiac resuscitation, inject into the ventricular cavity, not into the heart muscle.
  • Usual Adult Dosage: 200 to 800 mg (2 to 8 mL) when injected into the ventricular cavity.

INTRAVENOUS USE

Hypocalcemic Disorders

  • Usual Adult Dosage: 500 mg to 1 g (5 to 10 mL) at intervals of 1 to 3 days, depending on the response of the patient and / or results of serum calcium determinations. Repeated injections may be required because of rapid excretion of calcium.

Magnesium Intoxication

  • Initial Adult Dose: 500 mg (5 mL) administered promptly and the patient observed for signs of recovery before further doses are given.

Hyperkalemic ECG Disturbances of Cardiac Function

  • Dosage should be adjusted by constant monitoring of ECG changes during administration.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Calcium chloride in adult patients.

Non–Guideline-Supported Use

Indications and Dosing

  • Hypocalcemia: 200 mg to 1 g calcium chloride (2 to 10 mL of a 10% solution; 55 to 273 mg elemental calcium) IV every 1 to 3 days; max rate, 1 mL/min

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Indications

INTRACARDIAC USE

  • 0.2 mL/kg of body weight.

INTRAVENOUS USE

'Hypocalcemic Disorders'

  • 0.2 mL /kg of body weight. Maximum 1-10 mL/day.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Calcium chloride in pediatric patients.

Non–Guideline-Supported Use

Indications and Dosing

  • Advanced cardiac life support: 20 mg/kg calcium chloride (0.2 mL/kg of 10% solution; 5.5 mg/kg elemental calcium) IV or Intraosseous; administer slowly; max dose 2 g calcium chloride (546 mg elemental calcium).
  • Hypocalcemia: 2.7 to 5 mg/kg calcium chloride (0.027 to 0.05 mL/kg of a 10% solution; 0.74 to 1.37 mg/kg elemental calcium) IV every 4 to 6 hours; MAX rate, 1 mL/min.

Contraindications

Warnings

  • Calcium chloride should be injected into a large vein very slowly, as it may cause peripheral vasodilatation and a cutaneous burning sensation. A moderate fall in blood pressure due to vasodilatation may attend the injection. Since calcium chloride is an acidifying salt, it is usually undesirable in the treatment of hypocalcemia of renal insufficiency.

Adverse Reactions

Clinical Trials Experience

  • Rapid I.V. injection may cause the patient to complain of tingling sensations, a calcium taste, a sense of oppression or “heat wave.”
  • Injections of calcium chloride are accompanied by peripheral vasodilation as well as a local “burning” sensation, and there may be a moderate fall in blood pressure.

Postmarketing Experience

There is limited information regarding Calcium chloride Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Calcium chloride Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Calcium chloride in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Calcium chloride in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Calcium chloride during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Calcium chloride in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Calcium chloride in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Calcium chloride in geriatric settings.

Gender

There is no FDA guidance on the use of Calcium chloride with respect to specific gender populations.

Race

There is no FDA guidance on the use of Calcium chloride with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Calcium chloride in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Calcium chloride in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Calcium chloride in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Calcium chloride in patients who are immunocompromised.

Others

Administration and Monitoring

Administration

Intravenous

INJECT SLOWLY

  • Calcium Chloride Injection, USP, 10%, is administered only by slow intravenous injection (not to exceed 1 mL/min) and / or in cardiac resuscitation, by injection into the ventricular cavity. It must not be injected into the myocardium.
  • The usual precautions for intravenous therapy should be observed. If time permits, the solution should be warmed to body temperature. The injection should be halted if the patient complains of any discomfort; it may be resumed when symptoms disappear. Following injection, the patient should remain recumbent for a short time.

Monitoring

There is limited information regarding Calcium chloride Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Calcium chloride and IV administrations.

Overdosage

There is limited information regarding Calcium chloride overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

Calcium chloride
160px
Calcium chloride CaCl2.jpg
IUPAC name Calcium chloride
Other names Calcium(II) chloride, Calcium dichloride, E509
Identifiers
CAS number 10043-52-4
PubChem 24854
EC-number 233-140-8
DrugBank DB01164
ChEBI 3312
RTECS number EV9800000
ATC code A12AA07,B05XA07, G04BA03
SMILES [Ca+2].[Cl-].[Cl-]
InChI InChI=1/Ca.2ClH/h;2*1H/q+2;;/p-2
Properties
Molecular formula CaCl2
Molar mass 110.98 g mol-1
Appearance White powder, hygroscopic
Odor Odorless
Density 2.15 g/cm3 (anhydrous)
2.24 g/cm3 (monohydrate)
1.85 g/cm3 (dihydrate)
1.83 g/cm3 (tetrahydrate)
1.71 g/cm3 (hexahydrate)[1]
Melting point

772-775 °C, 270 K, -591 °F (
anhydrous[4]
260 °C (Expression error: Missing operand for *. )
monohydrate, decomposes
175 °C (Expression error: Missing operand for *. )
dihydrate, decomposes
45.5 °C (Expression error: Missing operand for *. )
tetrahydrate, decomposes[4]
30 °C (Expression error: Missing operand for *. )
hexahydrate, decomposes[1])

Boiling point

1935 °C, 2208 K, 3515 °F (
anhydrous[1])

Solubility in water Hexahydrate:
49.4 g/100 mL (−25 °C)
59.5 g/100 mL (0 °C)
65 g/100 mL (10 °C)
81.1 g/100 mL (25 °C)[1]
102.2 g/100 mL (30.2 °C)
α-Tetrahydrate:
90.8 g/100 mL (20 °C)
114.4 g/100 mL (40 °C)
Dihydrate:
134.5 g/100 mL (60 °C)
152.4 g/100 mL (100 °C)[2]
Solubility Soluble in CH3COOH, alcohols
Insoluble in liquid NH3, DMSO, CH3COOC2H5[3]
Solubility in ethanol 18.3 g/100 g (0 °C)
25.8 g/100 g (20 °C)
35.3 g/100 g (40 °C)
56.2 g/100 g (70 °C)[3]
Solubility in methanol 21.8 g/100 g (0 °C)
29.2 g/100 g (20 °C)
38.5 g/100 g (40 °C)[3]
Solubility in acetone 0.1 g/kg (20 °C)[3]
Solubility in pyridine 16.6 g/kg[3]
Acidity (pKa) 8–9 (anhydrous)
6.5–8.0 (hexahydrate)
Magnetic susceptibility −5.47·10−5 cm3/mol[1]
Refractive index (nD) 1.52
Viscosity 3.34 cP (787 °C)
1.44 cP (967 °C)[3]
Structure
Crystal structure Orthorhombic (rutile, anhydrous), oP6
Tetragonal (anhydrous, > 217 °C), oP6[5]
Trigonal (hexahydrate)
Space group Pnnm, No. 58 (anhydrous)
P42/mnm, No. 136 (anhydrous, > 217 °C)[5]
Lattice constant a = 6.259 Å Å,b = 6.444 Å Å,c = 4.17 Å (anhydrous, 17 °C)[5] Å
Lattice constant α = 90°, β = 90°, γ = 90°
Octahedral (Ca2+, anhydrous)
Thermochemistry
Std enthalpy of
formation
ΔfHo298
−795.42 kJ/mol (anhydrous)[1]
−1110.98 kJ/mol (monohydrate)
−1403.98 kJ/mol (dihydrate)
−2009.99 kJ/mol (tetrahydrate)
− 2608.01 kJ/mol (hexahydrate)[4]
Standard molar
entropy
So298
108.4 J/mol·K[1][4]
Standard molar
heat capacity
, cpo
72.89 J/mol·K (anhydrous)[1]
106.23 J/mol·K (monohydrate)
172.92 J/mol·K (dihydrate)
251.17 J/mol·K (tetrahydrate)
300.7 J/mol·K (hexahydrate)[4]
Hazards
EU classification Irritant Xi
EU Index 017-013-00-2
NFPA 704

NFPA 704.svg

0
2
1
 
R-phrases R36
S-phrases S22, S24
LD50 1000 mg/kg (rats, oral)[6]
Related Compounds
Other anions Calcium fluoride
Calcium bromide
Calcium iodide
Other cations Beryllium chloride
Magnesium chloride
Strontium chloride
Barium chloride
Radium chloride
Except where noted otherwise, data are given for
materials in their standard state
(at 25 °C, 100 kPa)

Infobox disclaimer and references

Mechanism of Action

There is limited information regarding Calcium chloride Mechanism of Action in the drug label.

Structure

Calcium Chloride Injection, USP, 10%, is a sterile aqueous solution containing, in each mL, 100 mg (1.36 mEq) calcium chloride. The pH of the solution may have been adjusted with hydrochloric acid and / or calcium hydroxide, when necessary. The air above the liquid in the individual containers has been displaced by flushing with nitrogen during the filling operation. The preparation contains no antimicrobial preservatives and is intended as a single-dose vial; once the unit is assembled and used, any remaining portion of the solution must be discarded with the entire unit. Calcium Chloride, USP, contains two molecules of water of hydration and is chemically designated as CaCl2 • 2H20.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Calcium chloride in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Calcium chloride in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Calcium chloride in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Calcium chloride in the drug label.

How Supplied

CALCIUM CHLORIDE INJECTION, USP, 10%

In unit-use packages containing a Luer-Jet™ Luer-Lock Prefilled Syringe. Stock No. 3304 NDC 76329-3304-1 10 mL Ten cartons per package.

Syringe Assembly Directions:

USE ASEPTIC TECHNIQUE

Do not assemble until ready to use.

This image is provided by the National Library of Medicine.

Storage

  • Store at controlled room temperature 15° to 30°C (59° to 86°F).

Images

Drug Images

Package and Label Display Panel

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Calcium chloride in the drug label.

Precautions with Alcohol

Alcohol-Calcium chloride interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

  • CALCIUM CHLORIDE®[7]

Look-Alike Drug Names

There is limited information regarding Calcium chloride Look-Alike Drug Names in the drug label.

Drug Shortage Status

Drug Shortage

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Template:CRC90
  2. Seidell, Atherton; Linke, William F. (1919). Solubilities of Inorganic and Organic Compounds (2nd ed.). New York: D. Van Nostrand Company. p. 196. 
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Anatolievich, Kiper Ruslan. "cadmium chloride". http://chemister.ru. Retrieved 2014-07-07. 
  4. 4.0 4.1 4.2 4.3 4.4 Pradyot, Patnaik (2003). Handbook of Inorganic Chemicals. The McGraw-Hill Companies, Inc. p. 162. ISBN 0-07-049439-8. 
  5. 5.0 5.1 5.2 Müller, Ulrich (2006). Inorganic Structural Chemistry. http://www.wiley.com (2nd ed.). England: John Wiley & Sons Ltd. p. 33. ISBN 978-0-470-01864-4. 
  6. "CALCIUM CHLORIDE - calcium chloride injection". 

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