title: Safety of compounded calcium chloride admixtures for peripheral intravenous administration in the setting of a calcium gluconate shortage.
abstract: Calcium gluconate is preferred over calcium chloride for intravenous (IV) repletion of calcium deficiencies in the inpatient setting. In the setting of a national shortage of IV calcium gluconate, our institution implemented a compounded calcium chloride admixture for IV administration. The objective of this analysis is to evaluate the peripheral infusion site safety of compounded IV calcium chloride admixtures in adult inpatients. A total of 222 patients, encompassing 224 inpatient admissions, from April to June 2011 were retrospectively reviewed. Sterile preparations of calcium chloride in 5% dextrose (600 mg/250 mL and 300 mg/100 mL) were used during the study time period. Adverse infusion site reactions were assessed using an institutional infiltration and phlebitis grading system. A total of 333 doses were administered peripherally. In all, 4 (1.8%) patients experienced a moderate to severe infusion site reaction, with 3 due to phlebitis and 1 due to infiltration. Naranjo Nomogram for Adverse Drug Reaction Assessment classified all 4 reactions to have a possible link to calcium chloride administration. Peripheral administration of compounded calcium chloride admixtures in 5% dextrose is associated with a low incidence of IV infusion site reactions and can be considered as an alternative in the event of a calcium gluconate shortage.
authors: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA kanger@partners.org.
authors: Kevin E
authors: KE
authors: Anger
authors: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors: Caryn
authors: C
authors: Belisle
authors: Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA.
authors: Megan B
authors: MB
authors: Colwell
authors: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors: Robert
authors: R
authors: Dannemiller
authors: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors: Burhan
authors: B
authors: Alawadhi
authors: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors: Alex
authors: A
authors: Wilkocki
authors: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors: Paul M
authors: PM
authors: Szumita
mesh_terms: D000368:Aged; D002118:Calcium / Q000172:deficiency; D002122:Calcium Chloride / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D002125:Calcium Gluconate / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005947:Glucose; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D005947:Glucose; D002122:Calcium Chloride; D002125:Calcium Gluconate; D002118:Calcium
keywords: calcium; calcium chloride; drug shortages; intravenous infusion; medication safety