The Hip: Preservation, Replacement and Revision

Calcium


- See: Calcium Supplements:

- Ionotropic Action: for acute Hypotension; (will raise the blood pressure, no matter what the cause of HypoTN)
     - comes as 1gm/10 ml in rapid injection syringes;
     - 1/4 amp (2.5 ml) for mild hypotension;
     - 1/2 amp (5.0 ml) for moderate hypotension;
     - full amp (10 ml) for severe hypotension;
     - MUST be given via a Central Line;

- Metabolic Derrangements:
     - acute hyperkalemia, hypocalcemia, & Ca channel blocker toxicity;
     - in emergency: 2-4mg/kg (? 2ml IV) IV slow 2 min push of a 10% solution, repeated in 10 min intervals;
     - w/  hypocalcemia, if patient has evidence oflaryngeal stridor or tetany, give same dose over 2 min, as a direct injection;

- Chronic Hypocalemia:
     - 1-2 gm PO qd; CaCl=270mg=13.6mEq elemental Ca/gm;
     - w/ Ca Gluconate=90mg = 4.5mEq= elemental Ca/gr;
     - careful if patient taking Digitalis;
     - for symptomatic hypocalcemia in the adult, try 1 gm of Ca gluconate in 20-100 cc of D5W or NS given over 20 min;
     - if serum PO4 is normal or low, then: Ca Gluconate 10-20ml (1-2gm) of 10% sol. IV in 100ml of D5W over 30 min;
     - begin PO Calcium: 200mg elemental Ca q2hr x 4 doses;
     - w/ moderate hypocalcemia after 6hrs, then give Ca gluconate 10ml (1gm) of 10% solution to 500 ml D5W, infused over 6hrs;
     - peds:
            - acute hyperK, HypoCal: 0.3 ml/kg IV (CaCl 10% or 100 mg/ml);
            - re-placement: Gluconate 500 mg/kg/day PO q4-8hrs;

- Cautions:
     - note: as with Potassium, Calcium infusions may produce severe tissue necrosis if concentrated solutions infiltrate peripherally;
     - Ca may be infused at 0.5 to 0.8 mEq/kg in parental solutions administered peripherally; Higher concentrations may be infused centrally



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, December 14, 2011 3:52 pm