Calcium for..anything

[AusPara]

Questions for those administering calcium for any indication. Particularly when administering packed red cells.

What are you indications (e.g. after 4 units, with every unit, only for iSTAT elevated k, ECG changes, etc.)

What is your view on treating severe hyperkalaemia of any cause, what is your approach if you do and what evidence informs it?

Could post your guidelines / protocols ( and evidence that informs them if available)?

 

[Peak]

Most commonly for an iCal <1.2 or empirically in CCB OD

It is important to remember that potassium is more than just a reflection of the extracellular concentration, but also a ration between intracellular and extracellular. A lack of gradient is what causes the lack of squeeze.

Realize that almost all of our field or ED interventions for hyper K are temporizing. A high K can stop the squeeze regardless of having a supplemented calcium. If you give insulin the K will eventually end up back outside of the cells in a few hours, much faster after stopping a continue neb. There are times to supplement electrolytes or correct ph balance, but I certainly wouldn’t overcorrect simply for hyperkalemia. Dropping K too quickly can cause ectopy, even of the K is corrected to a ‘normal’ level.

Renal failure needs to be addressed by renal replacement therapy whether that be HD, PD, CRRT, MUF, or whatever else.

 

[E tank]

Questions for those administering calcium for any indication. Particularly when administering packed red cells.

What are you indications (e.g. after 4 units, with every unit, only for iSTAT elevated k, ECG changes, etc.)

What is your view on treating severe hyperkalaemia of any cause, what is your approach if you do and what evidence informs it?

Could post your guidelines / protocols ( and evidence that informs them if available)?

In hospital response here, for what that's worth to you. Because I have ready access to POC ionized calcium, it's very rare that I would give calcium without demonstrated hypocalcemia.

Cases where I'm conducting massive transfusions would be in the setting of frequent ABG's which include iCa++. A hyperk arrest would be the exception.

The 'in between' type cases where I'm giving blood products on an urgent (as opposed to crash) situation the only other consideration is the dose I give and/or if I anticipate a fall in the calcium with my plans to give more.

If the calcium comes back borderline treatable and the patient's blood pressure is soft, I'll treat that.


Here's a thread that sort of talks about hyperK, tho that isn't what you specifically asked about and is certainly not the only reason to give calcium.

HyperK/Ventolin

Did this call yesterday: 58 y/o male with long hx of renal failure and dialysis. Missed his last 2 dialysis appointments and was c/o SOB and weakness. Also, numbness and difficulty moving his arms and legs. GCS 15, pale with cyanosis and difficulty breathing (lungs clear). No radial pulses but...

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