Calcium Chloride
Calcium chloride 10%
Brand names:Generic
A concentrated calcium salt (10% solution, 27.2 mg/mL elemental calcium) used to treat acute hypocalcemia, hyperkalemia, calcium channel blocker overdose, and magnesium toxicity. TCCC 2026 specifies 10 mL of 10% calcium chloride IV/IO after the first transfused blood product to address citrate-induced hypocalcemia. Calcium chloride delivers approximately three times the elemental calcium of an equivalent volume of calcium gluconate.
Pharmacology and Actions
Provides ionized calcium to restore normal extracellular calcium concentrations. Calcium is essential for cardiac contractility, vascular smooth muscle tone, coagulation cascade function (factor IV in the cascade), and neuromuscular function. In trauma resuscitation with blood products, citrate anticoagulant binds ionized calcium and produces hypocalcemia that worsens coagulopathy and reduces cardiac contractility; calcium replacement reverses this effect.
Indications
- Citrate-induced hypocalcemia following blood product transfusion (TCCC 2026 indication)
- Hyperkalemia with EKG changes (membrane stabilization)
- Calcium channel blocker or beta-blocker overdose
- Magnesium toxicity
- Symptomatic hypocalcemia (tetany, seizures, arrhythmia)
- Hydrofluoric acid burns or exposure
Absolute Contraindications
- Digitalis toxicity (calcium increases ventricular irritability and may cause cardiac arrest)
- Hypercalcemia
- Concurrent ceftriaxone in neonates (ceftriaxone-calcium precipitation in lungs and kidneys)
Precautions and Side Effects
Severe tissue necrosis with extravasation (worse than calcium gluconate due to higher calcium concentration). Bradycardia, asystole, or other arrhythmias with rapid administration. Hypotension with rapid push. Burning sensation at IV site. Hypercalcemia with over-administration. Peripheral IV administration acceptable but central access preferred for repeated dosing.
Adult Dosing
Pediatric Dosing
20 mg/kg IV/IO slow push over 2 to 5 minutes for hypocalcemia, hyperkalemia, or calcium channel blocker overdose. Maximum 1 g per dose. Pediatric trauma resuscitation guidance follows weight-based scaling of adult TCCC dosing.
Pharmacokinetics
Peak Effect: Within 1 minute
Duration: 30 minutes to 2 hours
Storage and Handling
Room temperature 15 to 30 degrees C; protect from freezing. Pre-filled syringes (10 mL of 10% solution, 1 g calcium chloride) and ampules available. Crystallization with cold storage; rewarm if crystallization observed before use.
Reconstitution:
10% solution is ready to use. Concentration: 100 mg/mL calcium chloride salt; 27.2 mg/mL elemental calcium. Do not mix with sodium bicarbonate or phosphate-containing solutions (precipitation).
TCCC and TECC Role
TCCC 2026 explicitly includes calcium replacement in the trauma fluid resuscitation protocol. After the first transfused blood product (whole blood or component), administer 10 mL of 10% calcium chloride OR 30 mL of 10% calcium gluconate IV/IO. The dose ratio reflects the higher elemental calcium content of calcium chloride per volume. Either preparation is acceptable; calcium chloride is operationally preferred when volume is restricted or rapid effect is needed.
Calcium chloride is the trauma-resuscitation companion to blood products in TCCC 2026 doctrine. Stored blood products contain citrate anticoagulant; citrate chelates ionized calcium; transfusion produces hypocalcemia that worsens the coagulopathy you are trying to treat. Calcium replacement breaks this cycle. The choice between calcium chloride (10 mL of 10%) and calcium gluconate (30 mL of 10%) is operational: calcium chloride delivers more elemental calcium per volume but has greater extravasation risk; calcium gluconate is safer for peripheral IV but requires three times the volume for equivalent effect. Either preparation works clinically; preference depends on access and operational constraints.
Confusing calcium chloride and calcium gluconate doses. The mistake of giving 30 mL of 10% calcium chloride (intending to give calcium gluconate volume) delivers three times the intended elemental calcium and can cause severe hypercalcemia and arrhythmia. Always specify which preparation and use the correct volume for that preparation. The other common mistake is rapid IV push, which can cause bradycardia or asystole; administer over 2 to 5 minutes through a flowing IV line.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Calcium Chloride
| IV/IO | TCCC 2026 trauma indication: 10 mL of 10% calcium chloride IV/IO (1000 mg of calcium chloride salt, equivalent to 272 mg elemental calcium) after first transfused blood product. Hyperkalemia: 500 to 1000 mg IV over 2 to 5 minutes, may repeat every 5 to 10 minutes. Calcium channel blocker overdose: 1 to 2 g IV bolus, may repeat or initiate infusion. (Immediate) |
| IM | None (severe tissue necrosis - never given IM) (None) |
| IN | None (None) |
| PO | None (None) |