Calcium Chloride vs Calcium Gluconate

  1. 0 This week I had and immediate post op emergent aortic valve replacement. He came back on Epi, Dopamine, Levophed and insulin drips. We started amniodarone soon after.
    Amongst other interventions we gave an amp of calcium gluconate.
    So what the difference between Cagluconate vs CaCl when addressing blood pressure?
  2. Visit  Manurse715 profile page

    About Manurse715

    Manurse715 has '2' year(s) of experience and specializes in 'ICU'. Joined Nov '08; Posts: 47; Likes: 21.

    14 Comments so far...

  3. Visit  stressgal profile page
    0
    My understanding is they have the same purpose/action. Calcium Gluconate is perferred as it is less irritating. Still nasty, worst infiltration I have ever seen.
  4. Visit  Manurse715 profile page
    0
    Using a central line. The patient seemed to improve after giving the CaGluconate and other stuff we did.
  5. Visit  COD123 profile page
    1
    The difference between calcium chloride and gluconate is the amount of elemental calcium. A 10% CaCl solution has 27mg/ml of elemental calcium whereas a 10% calcium gluconate solution has 9mg/ml.
    If you don't have a central line you use gluconate. In your case, it may be physician preference? Our standing orders for hearts have CaCl.
    NurseKitten likes this.
  6. Visit  aCRNAhopeful profile page
    0
    Quote from Manurse715
    So what the difference between Cagluconate vs CaCl when addressing blood pressure?
    I wasn't even aware that calcium was given for blood pressure. I'm new to CVICU so thats no big surprise but I guess I was under the impression it was for arrythmia prevention. Please explain the relationship between Calcium and blood pressure.
  7. Visit  aCRNAhopeful profile page
    0
    While your at it with my last question, here's another. Why is it that open hearts come back with low calciums and sometimes critical low calciums? My guess is that it is due to the amount of blood products they receive and the citrate preservative in them. Also, is there any signs and symptoms that you have noticed in an open heart pt with low Ca? Thank you in advance.
  8. Visit  Manurse715 profile page
    4
    COD 123, thanks for that info.
    aCRNAhopeful, Here's what I'm reading:
    Calcium played a major role in the initiation of sliding the filiments (actin and myosin) in the cardiac contraction. It is both a trigger for contraction and a regulatory factor for the process.
    The higher the concentration of Ca with in the sarcoplamic reticulum the greater the tension or functional inotropic force the heart can generate.

    from "aacn clincal reference for critical care nursing" Mosby 4th ed.

    Remember that Ca channel blocker slow conduction, decreases myocardial contractility, and causes some vaso-relaxation-decreased afterload and SVR that it stands to reason that giving a patient Calcium would do the opposite.
  9. Visit  Dinith88 profile page
    0
    Quote from Manurse715
    Remember that Ca channel blocker slow conduction, decreases myocardial contractility, and causes some vaso-relaxation-decreased afterload and SVR that it stands to reason that giving a patient Calcium would do the opposite.
    Yes!

    ...but you should qualify that by stating that it only helps if the patient is calcium deficient (as is fairly common s/p CABG). It wont 'do the opposite' and raise BP otherwise...
  10. Visit  meandragonbrett profile page
    0
    Quote from aCRNAhopeful
    I wasn't even aware that calcium was given for blood pressure. I'm new to CVICU so thats no big surprise but I guess I was under the impression it was for arrythmia prevention. Please explain the relationship between Calcium and blood pressure.
    Ca will alter your contractility when you're Ca is low. That's why you see a temporary increase in blood pressure and sometimes have to turn your pressors down. As already mentioned giving somebody CaCl when they are not Ca deficient is not going to have quite the same effect on the BP.
  11. Visit  meandragonbrett profile page
    0
    Quote from aCRNAhopeful
    Also, is there any signs and symptoms that you have noticed in an open heart pt with low Ca? Thank you in advance.
    Chvostek
  12. Visit  NurseKitten profile page
    1
    Unconscious patient with low Ca - first clinical sign you see is an increased Q-T interval. We don't get warning signs in anesthesia with parathyroidectomies - so that's what we look for.
    trixie333 likes this.
  13. Visit  TakeBack profile page
    0
    Ca is an inotrope and vasopressor- but notoriously short term.
    It is also a cofactor in the coag cascade, so it is useful in a postop heart, all of which are coagulaopathic.

    The hypoalbuminemia and hemodilution from CPB contribute to postop hypocalcemia.

    It is a good rescue drug for acute hemodynamic support but only as an adjunct to other drugs.
  14. Visit  clementinern profile page
    0
    In my facility, we typically use Calcium Gluconate to replace a low ionized ca of <1.20 and in non-urgent situations. Ca Chloride is reserved for critical hypotension, codes, or for hyperkalemia.

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