CH 15.10 Electrolyte & Buffer Drugs

Calcium Chloride Class

Electrolyte

Mechanism of Action of Calcium Chloride

Increases serum calcium levels and enhances myocardial contractility

Indications for Calcium Chloride

Hyperkalemia, calcium channel blocker overdose, magnesium toxicity

Contraindications for Calcium Chloride

Hypercalcemia, ventricular fibrillation (relative)

Adverse Reactions of Calcium Chloride

Tissue necrosis with extravasation, bradycardia, dysrhythmias

Dosage and Administration for Calcium Chloride (Adult)

1 g IV slow push

Dosage and Administration for Calcium Chloride (Pediatric)

20 mg/kg IV slow

Duration of Action for Calcium Chloride

Onset immediate, duration variable

Calcium Gluconate Class

Electrolyte

Mechanism of Action of Calcium Gluconate

Increases serum calcium and stabilizes cardiac membrane

Indications for Calcium Gluconate

Hyperkalemia, hypocalcemia, calcium channel blocker overdose

Contraindications for Calcium Gluconate

Hypercalcemia

Adverse Reactions of Calcium Gluconate

Hypotension, bradycardia, less tissue irritation than calcium chloride

Dosage and Administration for Calcium Gluconate (Adult)

1–3 g IV slow push

Dosage and Administration for Calcium Gluconate (Pediatric)

60 mg/kg IV slow

Duration of Action for Calcium Gluconate

Onset minutes, duration variable

Magnesium Sulfate Class

Electrolyte

Mechanism of Action of Magnesium Sulfate

Decreases neuromuscular excitability and stabilizes cardiac cells

Indications for Magnesium Sulfate

Torsades de pointes, hypomagnesemia, eclampsia, severe asthma

Contraindications for Magnesium Sulfate

Heart block, renal failure

Adverse Reactions of Magnesium Sulfate

Hypotension, respiratory depression, cardiac arrest

Dosage and Administration for Magnesium Sulfate (Adult)

1–4 g IV over 10 minutes

Dosage and Administration for Magnesium Sulfate (Pediatric)

25–50 mg/kg IV

Duration of Action for Magnesium Sulfate

Onset immediate, duration variable

Sodium Bicarbonate Class

Buffer, alkalinizing agent

Mechanism of Action of Sodium Bicarbonate

Binds hydrogen ions to raise pH and correct metabolic acidosis

Indications for Sodium Bicarbonate

Metabolic acidosis, hyperkalemia, tricyclic antidepressant overdose, ROSC

Contraindications for Sodium Bicarbonate

Alkalosis, hypokalemia, hypocalcemia

Adverse Reactions of Sodium Bicarbonate

Metabolic alkalosis, electrolyte imbalance, fluid overload

Dosage and Administration for Sodium Bicarbonate (Adult)

1 mEq/kg IV

Dosage and Administration for Sodium Bicarbonate (Pediatric)

1 mEq/kg IV

Duration of Action for Sodium Bicarbonate

Onset 2–10 minutes, duration 30–60 minutes