Which medications in the drug class Calcium salts are used in the treatment of Hyperkalemia?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Calcium salts

Calcium antagonizes the cardiotoxicity of hyperkalemia by stabilizing the cardiac cell membrane against undesirable depolarization. Onset of effect is rapid (≤ 15 minutes) but relatively short-lived. These agents are the first-line treatment for severe hyperkalemia (ie, >7 mEq/L), when the electrocardiogram (ECG) shows significant abnormalities (eg, widening of QRS interval, loss of P wave, or cardiac arrhythmias). Calcium usually is not indicated when the ECG shows only peaked T waves.

Calcium has no effect on the serum level of potassium. For that reason, administration of calcium should be accompanied by the use of other therapies that actually help lower serum potassium levels.

Calcium chloride contains about 3 times more elemental calcium than an equal volume of calcium gluconate: 1 g of calcium chloride has 270 mg (13.5 mEq) of elemental calcium, whereas 1 g of calcium gluconate has 90 mg (4.5 mEq). Therefore, when hyperkalemia is accompanied by hemodynamic compromise, calcium chloride is preferred to calcium gluconate. Other calcium salts (eg, glubionate and gluceptate) have even less elemental calcium than calcium gluconate and generally are not recommended for therapy of hyperkalemia.

Calcium gluconate

Calcium increases the threshold potential, thus restoring the normal gradient between threshold potential and resting membrane potential, which is abnormally elevated in hyperkalemia. Onset of action is within 5 minutes, and duration of action is about 30-60 minutes. Doses should be titrated with constant monitoring of ECG changes during administration; repeat the dose if ECG changes do not normalize within 3-5 minutes.

Calcium chloride

Calcium prevents the deleterious cardiac effects of severe hyperkalemia that may occur before the serum potassium level is corrected. Because of its irritating effects when administered parenterally, calcium chloride is generally considered a second choice, after calcium gluconate.

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