Calcium Chloride vs Calcium Gluconate

  1. 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?
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  2. 23 Comments

  3. by   stressgal
    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. by   Manurse715
    Using a central line. The patient seemed to improve after giving the CaGluconate and other stuff we did.
  5. by   COD123
    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.
  6. by   aCRNAhopeful
    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. by   aCRNAhopeful
    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. by   Manurse715
    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. by   Dinith88
    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. by   meandragonbrett
    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. by   meandragonbrett
    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. by   NurseKitten
    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.
  13. by   TakeBack
    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. by   clementinern
    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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