Ionized calcium

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Why do some doctors want to check an ionized calcium before replacing, while others just replace the calcium based on the bmp?

Also on my adult medsurg floor we usually use calcium gluconate. When I was in the peds cardiac icu we used calcium chloride. Why is one used vs the other?

Thanks! I'm not exactly a new rn anymore. Just wondering about this and haven't found a straight answer.

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Specializes in Emergency.
Why do some doctors want to check an ionized calcium before replacing, while others just replace the calcium based on the bmp?

Also on my adult medsurg floor we usually use calcium gluconate. When I was in the peds cardiac icu we used calcium chloride. Why is one used vs the other?

Thanks! I'm not exactly a new rn anymore. Just wondering about this and haven't found a straight answer.

1. Ionized calcium is a more accurate measure of the calcium available for the body to use as serum calcium level includes albumin bound as well. Especially if the patient has an abnormal albumin many docs will like to see the ionized level prior to replacing. At my place of work we use a simple calculation to correct calcium levels for albumin, so perhaps some if your docs do that instead of an iCa++.

2. Calcium is very irritating to tissue and can cause necrosis and calcification if extravasated, calcium gluconate is less irritating than calcium chloride and so safer and preferred in non-emergent situations. We push calcium chloride in code situations, it provides more elemental calcium, and is preferred for rapid replacement and treatment if arrhythmias. It is policy for us that continuous ECG monitoring be in place when calcium chloride is administered, but not when calcium gluconate is.

Hope that helps!

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Perfect! Thank you!

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