another ICU nurse's opinion

Specialties MICU

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Specializes in critical care nursing.

I have some questions for all experienced ICU nurses. If you had a patient with ESRD who has hypocalcemia and could be symptomatic. FYI: this patient has an AV fistula. If the doctor(renal) writes the following orders: Calcium Chloride 7.4gm in sodium chloride 0.9% INJ 100ml as directed. 7.4gm=100meq final concentration of 1meq/ml. Goal Calcium between 4 and 5, if ionized calcium below 4, increase drip by 1meq, if above 5 decrease by 1meq. What would you do?

Also, if you found the patient to have ion ca+ 3.7, what would you do?

Does your facility have a policy as to the "standard concentration" and route(central or peripheral) of administering Calcium Chloride Infusion?

I appreciate any help . Thank you

A Fellow SICU nurse.

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Specializes in critical care nursing.

I have some questions for all experienced ICU nurses. If you had a patient with ESRD who has hypocalcemia and could be symptomatic. FYI: this patient has an AV fistula. If the doctor(renal) writes the following orders: Calcium Chloride 7.4gm in sodium chloride 0.9% INJ 100ml as directed. 7.4gm=100meq final concentration of 1meq/ml. Goal Calcium between 4 and 5, if ionized calcium below 4, increase drip by 1meq, if above 5 decrease by 1meq. What would you do?

Also, if you found the patient to have ion ca+ 3.7, what would you do?

Does your facility have a policy as to the "standard concentration" and route(central or peripheral) of administering Calcium Chloride Infusion?

I appreciate any help . Thank you

A Fellow SICU nurse.

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Specializes in ICU/CCU, PICU.

Go down on the drip by 1ml - this is also assuming it's per hour. I've never had a CaCl- infusion.

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Specializes in ER trauma, ICU - trauma, neuro surgical.

I've seen a calcium gtt once (for Ca channel blocker overdose), so not sure if we have a protocol. I'm sure we do or pharmacy knows. If the ionized Ca was 3.7 and the goal is 4-5, then from what the dosing say, I would increase it by 1 meq. Would need more info on the starting dose (1meq/hr?) and how often to draw ionized Ca levels.

I would assume a CaCl infusion would need a central line. Ca infiltration would destroy skin and tissues.

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That seems like a heck of a lot of work running a calcium drip if it's only for hypocalcemia (not a beta-blocker OD like mentioned). Even when I've had really sick patients with very low ICal's, all I've ever done is IVPB replacements.

If it's renal failure, makes me think their phosphorus levels are sky high if the calcium is low. Fix that issue first if that's the case (with HD), don't just mask it with a calcium infusion.

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