Calcium Salts

What it is used for

• Hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Acute hypocalcemia secondary to hypoparathyroidism
• Hypocalcemia secondary to phosphate enema toxicity or puerperal tetany
• Emergency treatment of hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Hypocalcemia
• Lactation tetany

How it is given

Possible side effects

• Hypercalcemia
• GI irritation and/or constipation (oral administration)
• Mild to severe tissue reactions, pyogranulomatous panniculitis, adipocyte mineralization (IM or SC administration)
• Venous irritation (IV administration)
• Hypotension (if given IV too rapidly)
• Cardiac arrhythmias and cardiac arrest (if given IV too rapidly)

Cautions & contraindications

• Ventricular fibrillation
• Hypercalcemia
• > **WARNING:** Intravenous calcium must be administered **SLOWLY** while continuously monitoring the ECG and/or heart rate. Too rapid administration can cause fatal arrhythmias, bradycardia, hypotension, and cardiac arrest. If bradycardia or Q-T interval shortening occurs, halt the infusion immediately. * **Extravasation Risk:** Calcium salts (especially calcium chloride) are highly irritating. Perivascular administration can cause severe tissue necrosis. If extravasation occurs, stop infusion, infiltrate with normal saline, apply heat, and consider local corticosteroids or 1% procaine/hyaluronidase. * **Subcutaneous Use:** While historically used SC in dogs/cats, it is now known to cause severe tissue reactions (pyogranulomatous panniculitis, mineralization) and should be used with extreme caution or avoided if possible. * **Acid-Base/Renal:** Calcium chloride is acidifying; use with caution in respiratory failure, respiratory acidosis, or renal disease.

Drug interactions

• Calcium Channel Blockers (e.g., diltiazem, verapamil): Intravenous calcium may antagonize the effects of calcium-channel blocking agents.
• Digoxin: Patients on digitalis therapy are more apt to develop arrhythmias if receiving IV calcium; use with extreme caution.
• Magnesium (oral): May lead to increased serum magnesium and/or calcium, particularly in patients with renal failure.
• Magnesium Sulfate (parenteral): Parenteral calcium can neutralize the effects of hypermagnesemia or magnesium toxicity secondary to parenteral magnesium sulfate.
• Neuromuscular Blockers (e.g., atracurium, vecuronium, tubocurarine): Parenteral calcium may reverse the effects of nondepolarizing neuromuscular blocking agents; has been reported to prolong or enhance the effects of tubocurarine.
• Tetracyclines, Fluoroquinolones (oral): Oral calcium can reduce the amount of these antibiotics absorbed from the GI tract via chelation; separate dosages by at least two hours.
• Potassium Supplements: Patients receiving both parenteral calcium and potassium supplementation may have an increased chance of developing cardiac arrhythmias.
• Thiazide Diuretics: Used in conjunction with large doses of calcium may cause hypercalcemia.
• Vitamin A: Excessive intake may stimulate calcium loss from bone and cause hypercalcemia.

Frequently asked questions