What is the role of calcium therapy in the treatment of calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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Calcium can be administered intravenously to patients who present with symptomatic hypotension or heart block. [5, 6, 7] High-dose calcium theoretically creates a concentration gradient large enough to partially overcome the channel blockade, driving calcium into the cells. Calcium is usually administered as calcium gluconate or calcium chloride. Calcium chloride is sclerosing to veins so should be avoided in children, and it should be used in adults only in a larger, free-flowing IV line. Calcium chloride has 4 times the calcium content as calcium gluconate.

Calcium gluconate, 30 mL of 10% solution, can be administered IV over 10-15 minutes in adults. The recommended pediatric dose of calcium gluconate is 60 mg/kg, with a maximum dose of 1 g. [8] Calcium chloride (1-4 g) is preferably given via central line, slowly. The bolus can be repeated, or a slow calcium infusion (eg 20-50 mg/kg/h) can be implemented.

Calcium gluconate boluses may be repeated every 15-20 minutes, if the response to the initial bolus begins to diminish, for a total of 3 doses. After the third bolus, the ionized calcium level should be checked. In cases of severe calcium channel blocker toxicity, serum calcium concentrations have been titrated to 1.5-2 times the upper limit of normal, leading to improved cardiac function.

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