Calcium Replacement

OVERVIEW

• controversial issue
• generally accepted that patient should have replacement if ionised Ca²⁺ < 0.8mmol/L

Advantages

• improves inotropy
• stabilises myocardium if patient in a hyperkalaemic cardiac arrest
• useful in Ca²⁺ channel blocker overdose and massive transfusion
• easy to administer (IV bolus)
• some data saying increased mortality and length of ICU stay if not corrected

Disadvantages

• extravasation -> tissue necrosis
• can precipitate if administer with bicarbonate
• increase in cytosolic Ca²⁺ -> cytotoxic -> disruption of intracellular processes -> ischaemia and reperfusion injury
• increase in coronary and cerebral vasospasm
• rapid administration: nausea, flushing, headache and arrhythmias
• requires correction of Mg²⁺ to be effective
• in hyperphosphataemia -> may cause calcium precipitation in tissues
• in rat endotoxin model -> Ca²⁺ replacement caused an increase in mortality

References and Links

• CCC – Calcium metabolism
• CCC – Calcium basics
• CCC – Hypercalcaemia Overview
• CCC – Hypercalcaemia DDx
• CCC – Hypocalcaemia
• CCC – Hypocalcaemia DDx
• CCC – Calcium replacement (advantages/disadvantages)
• CCC – Calcium as an inopressor