UNCONTROLLED WHEN PRINTED
Introduction
  • 2.2 mmol / 10ml vial (0.22mmol/ml)
  • Provides immediate stabilisation of the myocardium in hyperkalaemia
  • Opposed blockade of calcium channels by drugs; alters membrane polarisation; chelates fluoride ions
  • Onset 1-3 minutes
  • Peak duration 30-60 minutes
Indications
  • Major haemorrhage where 2 or more units of Red Blood Cells have been administered
  • Crush Injury with ECG signs associated with hyperkalaemia
  • ECG Signs of Hyperkalaemia
    • Tall tented T-waves
    • Absent p-waves
    • Widened QRS
    • Sine Wave
  • Calcium channel blocker toxicity (particularly verapamil or diltiazem)
Contraindications
  • Hypersensitivity
  • Suspected Digoxin Toxicity
Precautions / Notes
  • This is a HIGH-RISK medication and is rapidly fatal in overdose
  • Monitor ECG with IV administration
  • Extravasation can cause tissue necrosis; do not give via SC or IM routes. Monitor the injection site closely
  • If given too fast it may cause hot flushes, chalky taste, peripheral vasodilation, hypotension, bradycardia, cardiac dysrhythmias, syncope and cardiac arrest
Management
Critical Care Paramedic only
  • Adult
    • 10ml (2.2 mmol) IV/IO slow push over 3-5 minutes
    • Repeat dose once or twice if required (titrated against ECG changes)
  • Paediatric
    • 0.7ml/kg (0.15 mmol/kg) IV/IO slow push over 3-5 minutes to a maximum dose 10ml (2.2 mmol)
    • Repeat dose once or twice if required (titrated against ECG changes)
Special Considerations
  • Allergy
  • Vasodilation / Syncope
  • Hypotension
  • Bradycardia
  • Cardiac Dysrhythmias

References
References
Presentation
  • 2.2mmol in 10mL (0.22 mmol / ml) solution for injection
calcium gluconate
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