Calcium – useful antidote for calcium channel blockers, hydrofluoric acid exposure to skin or systemic fluorosis, ethylene glycol (hypocalcaemia), hyperkalaemia and iatrogenic hypermagnesaemia.
- 0.5-1g (5-10ml) of calcium chloride or 1-2g (10-20ml) of calcium gluconate IV over 5-10 minutes.
- Repeat every 10-15 minutes as required. Usually this is guided by serum calcium concentrations or the QT interval on the ECG.
- Calcium chloride can be given as a bolus into a large vein and does not require metabolism by the liver to work, however, if it extravasates local tissue damage can occur.
Calcium channel blocker poisoning
- Give 2g (20ml) of calcium chloride IV or 6g (60ml) of calcium gluconate IV over 5-10 minutes.
- This dose may be repeated every 20 mins for up to three doses
Hydrofluoric (HF) acid skin exposure
- Topical 2.5% calcium gel – place on minor burns or if on the hand place gel into a glove followed by the injured hand (mix 10mL of 10%calcium gluconate solution with 30 mL lubricant jelly).
- Local injection of calcium gluconate 1g/10ml intradermal or subcutaneously (not into fingers) if topical solution does not work. Do not use calcium chloride as this will cause tissue injury
- Bier’s block is the third line or used if there is a large HF burn. Use as per normal Bier’s technique for 20 minutes. Inject 1g (10ml) of calcium gluconate in 40ml of 0.9% saline. Do not use calcium chloride as this will cause tissue injury
- Intra-arterial infusion. As a final alternative, if pain is still an issue it is possible to infuse a solution into an artery of the affected limb. Dilute 1g (10ml) of calcium gluconate in 40ml go 0.9% saline over 4 hours and repeat as required. Do not use calcium chloride as this will cause tissue injury
Hydrofluoric acid inhalation injury
- Give nebulised 2.5% calcium gluconate solution.
- For hypocalcaemia or calcium channel blocker poisoning use 0.5ml/kg of 10% calcium gluconate (max dose 20ml) over 5-10 minutes and repeat after 10-15 minutes if necessary.
- Albertson TE, Dawson AH, de Latorre F et al. TOX-ACLS: toxicologic-oriented advanced cardiac life support. Annals of Emergency Medicine 2001; 37:S78-S90.
- Vance MV, Curry SC, Kunkel DB et al. Digital hydrofluoric acid burns: treatment with intraarterial calcium infusion. Annals of Emergency Medicine 1986; 15:890-896.
- Graudins A, Burns MJ and Aaron CK. Regional intravenous infusion of calcium gluconate for hydrofluoric acid burns of the upper extremity. Annals of Emergency Medicine 1997; 30:604-607.