This document provides information on calcium chloride, calcium gluconate, magnesium sulfate, sodium bicarbonate, and potassium chloride. It lists the recommended daily allowances, forms, indications and dosages for treating conditions like hypocalcemia, preeclampsia, magnesium deficiency, metabolic acidosis, and hypokalemia. Precautions for use in renal impairment and drug interactions are also outlined.

1. Dr JANVI SARMA
MBBS MD
DRUGS: CALCIUM CHLORIDE,CA
LCIUMGLUCONATE,MGSO4,KCL,NAHCO3

2. CALCIUM
• RDA (elemental)
1. 1-1.2 g (adults)
2. 200mg (1-6mons)
3. 260mg(6-12mons)
4. 700mg(1-3yrs)
5. 1000mg(4-8yrs)
6. 1300mg(9-18yrs)

3. • 2 forms
1. Ca chloride
2. Ca gluconate
• Both available as 10% w/v
• Elemental Ca in Cacl2 = 1g=273mg =13.6MEq= 6.8mmol
• Elemental Ca in Ca gluconate=1g= 93 mg=4.65MEq

4. • Indications :-
1. Hypocalcemic tetany
2. Hypocalcemia d/t hypopatathyroidism
Dose:
 Cacl2- acute symptoms- 200-1000mg or 2.7-5mg/kg
every 4-6hrs.
 Ca gluconate- 1-2 g over 2hrs.or

5.  Severe symp- 1g over 10mins,repeat every 10mins
until symptoms resolve
 Ca gluconate- 1-2 g over 10mins,repeat every 60mins
until symp resolve.infusion- 5-20mg/kg/hr
Note: i.v ca gluconate preferred over ca chloride d/t
potential of extravasation with cacl2.

6. 3. BB overdose-
Dose:-
 Cacl2- 20mg/kg over 5-10mins f/b 20mg/kg/hr titrated
to adequate hemodynamic response
4. CCB overdose-
Dose-
 Cacl2- 1-2g over 5mins,may repeat every 10-20mins
 Ca gluconate- 60mg/kg/dose(max-3-6g/dose)over
5mins.may repeat 3-4 additional doses.

7. 5. Cardiac toxicity d/t- ↓ca/-
 Cacl2- 500-1000mg over 2-5mins.repeat as
necessary/20mg/kg(max 2g)
 Ca gluconate- 1.5-3g over 2-5 mins.peds- 60-
100mg/kg/dose( max-3g/dose).
6. In hyperkalemia as membrane stabiliser

8. ADR
• CVS- brady/arrest/arrythmias/hypotension/syncope
• CNS- tingling sensation
• Endo/metabolic- hot flush
• GIT- chalky taste,GI irritation
• Local- tissue necrosis
• Renal- nephrolithiasis

9. INTERACTIONS
• Increased risk of cardiac arrythmias when used with
cardiac glycosides.
• Concurrent use with NMBA reverse their effect
• Acidosis- use with caution in pts with resp
acidosis,renal imapirment- acidifyoing effect of Cacl2.
• ↑phosphatemia- use with caution as elevated levels of
pos & Ca may result in softvtissue & pul art Ca-Po4
precipitation.

10. CONT…..
• Hypokalemia- use with caution in pts with severe
hypoK as acute rise in Ca can result in life threatening
arrythmias.
• Ceftriaxone- Concurrent use may cause precipitation.
• Dobutamine- Ca salts may diminish the therapeutic
effect of dobutamine.
• Thiazide- It may decrease excretion of Ca salts & may
cause met alkalosis.
• Hypo Mg- It is common cause of hypo Ca.

11. MAGNESIUM SULPHATE

12. • 4th m/c cation in the body
• 60% present in bones
• Imp roles in – N-M function & CV tone
• RDA: (Mg)
1. 310-400mg (adult)
2. 80mg (1-3yrs)
3. 130mg(4-8yrs)
4. 240mg(9-13yrs)
5. 350mg( Preg)

13. • MgSo4- available as 50% w/v
• 1ml = 500mg = 4MEq
• 1 Meq = 123mg of MgSO4
• 1 mmol = 2MEq = 24mg of elemental Mg
• PD’s & Pk’s
 Onset – i.m – 1hr , i.v – immediate
 DOA- im- 3-4hrs , i.v- 30mins
 Protein binding – 30% to albumin
 Excreted in urine

14. INDICATIONS
1. Severe pre eclampsia & eclampsia
2. Hypomagnesemia –
 Mild- 1 g every 6hrs
 Mild-mod- 1-4g. /> 12g in 12hrs
 Severe-4-8g at <1g/hr
 Severe symp- <4g over 4-5mins

15. 3. Correction of hypokalemia
4. TDP- 1-2 g over 1-2 mins
5. Acute severe exacerbation- 2g as a single dose over
20mins.Peds- 25-75mg/kg/dose.max 2g
6. Part of TPN- 8-24MEq of elemental Mg daily
7. To attenuate intubation response

16.  In impairments:
1. Hepatic- no adjustment
2. Renal- dec by 50%. In eclampsia not >20g/48hrs
 Compatibility- DNS/D5/LR/NS.incompatible with fat
emulsion.
 ADR:
1. CVS- flushing,hypotension
2. Endo- hyper Mg

17. • CI
1. Heart block
2. Myocardial damage
• Precautions/cautions
1. In pts with N-M ds
2. Renal impairment
3. Check DTR every 15mins.Disappearance of patellar
reflex is useful clinical sign to detect onset of Mg
intoxication.Knee jerk should be tested before
repeating dose

18. 4. Periodic monitoring of S.Mg is essential.Keep S.Mg
<2.5MEq/L.If >3.5 discontinue infusion.
5. UO = 100ml/4hrs

19. INTERACTIONS
• Biphosphonate derrivatives- Mg salts may dec the
S.conc of biphos.Avoid administration of oral Mg salts
within 2hrs before/after. Exception- Pamidronate
• CCB- It may enhance the toxic effects of Mg salts
• CNS depressants- MgSO4 may enhance the effects of
these drugs
• Levothyroxine- Mg salts may dec the S.conc of
levothyroxine.Gap of atleast 4hrs req.

20. NAHCO3

21. • Hypertonic solution
• Conc- 4.2%, 5%,7.5% (22.5Meq /ampoule), 8.4% w/v
• w/v- mass of solute/vol of sol * 100
• Contents: 1 Meq = 84mg , 1g= 12MEq of Na & Hco3
• 84mg/ml NaHCO3 ( 1:1 Na : Hco3 /ml)
• MOA- increases plasma HCO3, buffers excess of H
ions & increases blood ph

22. • Uses:
1. Met acidosis- when ph <7.1
 guidelines for using NAHCO3 in met acidosis
 Why to treat?
• Met acidosis supress cardiac contractility
• Persistent acidosis will consume the bone buffers &
cause osteoporosis.

23.  How much ?
• Amount of NAHCO3 req= 0.5*wt* (desired- actual)
OR
• Dose( Meq) = 0.3* Wt* BE
 How to infuse
• In absence of CI,50% of calculated deficit is corrected
in 4hrs & rest gradually over 24hrs
• To avoid irritation of veins,its added to D5.

24. SPECIAL PRECAUTIONS
• NAHCO3 should not be used as bolus
• Never treat acidosis without treating the etiology
• Never correct acidosis without correcting associated
hypoK.because by correcting acidosis,NAHCO3 will
shift K intracellularly
• Do not mix with Ca- precipitation

25. USES CONTD…..
2. Salicylate poisoning.
3. TCA overdose
4. Methanol poisoning
5.Hyper K- 50MEq over 5 mins (ACLS 2010)
6. Urine alkalinization- 48MEq, then 12-24 Meq every 4
hrs.Doses adjusted to desired urinary pH.

26. 7. CIN- (off label use) – 154 Meq/L in D5 @ 3ml/kg/hr *
1hr before contrast,then 1ml/kg/hrhr during contrast &
for 6 hrs after procedure.
8. Cardiac arrest- 1 Meq/kg/dose
** Routine use not recommended ( in some situations like
arrest d/t met acidosis/hyper K/ TCA overdose.

27. • ADR:
1. CVS- CHF,edema
2. Cerebral H
3. CNS- tetany
4. GIT- gastric distension/flatulence
5. Endo/metabolic- hyper Na/hyper osm/hypo
kalemia/hypo Ca
6. Resp- pul edema

28. INTERACTIONS
1. Acetazolamide- May increase the toxic effects of
NAHCO3
2. Alpha & Beta agonist- Alkalinizing agents may
increase the S.conc
3. Cefodoxime/Cefuroxime- Antacids may dec S.conc

29. KCL

30.  RDA
• 40-80 Meq/day
• 2-3 Meq/kg/day (children)
• 2-6 Meq/kg/day ( Infants)
 Total body K- 3500 Meq ,(98% is IC & 2% EC)
 Uses:
• Conduction of nerve impulses in brain,heart,sk muscle
• Contraction of muscles

31. Composition
• Inj Kcl- 15% = 10ml
• 1ml= 150mg=2Meq
• 10ml=1.5g=20Meq
Indications
1. Hypokalemia
2. Added to K free peritoneal dialysis fluid to
maintain proper K level
3. During CPB Sx

32.  Basic rules
• Max dose- 20 Meq/hr thr peripheral line & 40 Meq/hr thr
central line
• Ideally ≠20/hr, ≠40/L, ≠240/day
• Av rise of K is 0.25Meq/L when 20Meq is given during
1hr
• 1Meq fall in S,pot = 200-400Meq of total body pot
deficit.
S.K >3.5 3 2 <2
TOTAL K
DEFICIT
0 300 450-600 >600

33. • ADR:
Skin- rash
Endo – hyper K
GIT- abd pain/diarrhoea/GI bleed/ GI perforation(oral)/N+V.
• Warnings
1. Acid base dis
2. CVS ds- pts are prone to cardiac effects with hypo/hyper
K
3. Renal impairment- use with caution
4. Pts on digitalis

34. • Drug interactions:
1. ACEI/AR2 B
2. Anticholinergics – may enhance ulcerogenic effect of
Kcl
3. Heparin – May increase hyperkalemic effect of Kcl.

35. THANK YOU