G251(P) Which calcium is best in paediatric resicitation? Calcium chloride versus calcium gluconate for the treatment of hypocalcemia in acute setting: an evidence based systematic review. (25th October 2020)

• Record Type: Journal Article
• Authors: Kanaris, C; Janjanam, A; Palaniappan, S
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A91
• Page End: A91
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.217
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction/Objective: A 2-year-old girl admitted with severe Group A streptococcal septic shock was resuscitated with blood products and polyinopressor support. She had persistent refractory hypocalcaemia despite multiple corrections with calcium gluconate which prompted us to do a systematic literature review for evidence regarding the usage of Calcium Gluconate and Calcium Chloride in the management of acute hypocalcemia, especially to ascertain if one confers a faster rise in iCa when used in an emergency. Secondary objectives we looked at included the pharmacokinetic basis, therapeutic efficacy, adverse event profile and physiological implications, again intending to clarify if there should be a clinical preference of one over the other in emergencies. Methods: Literature review using Cochrane library, Embase and Medline OVID interface. Papers published between January 1980 and October 2019 Results: It is purported that Calcium Gluconate requires hepatic metabolism to release ionised Calcium, precluding its use in conditions of shock, cardiac arrest and hepatic impairment, presumably due to lower bioavailability and suboptimal biochemical effect. On the other hand, it is suggested that Calcium Chloride supposedly has rapid ionisation time, and could, in theory, provide ionised Calcium more quickly. This physiological reasoning is why historically, Calcium Chloride has been preferred in clinical situations where a rapid iCa is required like the scenarios mentioned above. However, the evidence for this seems to be mixed and inconclusive. Additionally, Calcium Chloride appears to be worse an irritant comparatively and is more likely to cause tissue necrosis with extravasation, thereby rendering Calcium Gluconate a safer option when used peripherally.