Journal of anesthesia, analgesia and critical care · 2026
Which calcium preparation should we use in paediatric resuscitation? A comprehensive review of basic physiology, pharmacokinetics, and clinical evidence.
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Kanaris Constantinos, Subhash Swathy, Camporesi Anna
Аннотация
BACKGROUND: The optimal choice between calcium gluconate (CaGN) and calcium chloride (CaCl₂) for hypocalcaemia correction during paediatric critical illness and resuscitation remains debated. This literature review aimed to compare the efficacy and safety profiles of both preparations to determine an evidence-based clinical preference.
METHODS: A comprehensive review of in vitro, in vivo, and clinical trials involving critically ill patients was conducted, focusing on the pharmacokinetics, therapeutic efficacy (measured by the rise in ionised calcium, iCa2⁺), and comparative adverse event profiles, particularly the risk of extravasation injury.
RESULTS: Both CaGN and CaCl₂ effectively correct hypocalcaemia when equivalent elemental calcium doses are administered. CaCl₂ holds a significant dosing advantage in volume-restricted or extreme emergent scenarios due to its higher concentration of elemental calcium (27.2 mg/mL vs. 9.0 mg/mL for 10% solutions). Whilst the hepatic metabolism requirement for CaGN has been widely refuted, limited paediatric data suggest CaCl₂ may yield a greater response in mean arterial pressure (MAP) in critically ill children. Crucially, the safety profile favours CaGN; a substantial body of evidence indicates that the risk and severity of tissue necrosis following extravasation are markedly higher with CaCl₂.
CONCLUSION: The selection of a calcium preparation must be conditional and context-dependent. We recommend reserving CaCl₂ for central venous administration in volume-restricted or extreme emergent settings, whilst CaGN is the preferred choice for peripheral line administration or routine maintenance due to its superior safety profile.
METHODS: A comprehensive review of in vitro, in vivo, and clinical trials involving critically ill patients was conducted, focusing on the pharmacokinetics, therapeutic efficacy (measured by the rise in ionised calcium, iCa2⁺), and comparative adverse event profiles, particularly the risk of extravasation injury.
RESULTS: Both CaGN and CaCl₂ effectively correct hypocalcaemia when equivalent elemental calcium doses are administered. CaCl₂ holds a significant dosing advantage in volume-restricted or extreme emergent scenarios due to its higher concentration of elemental calcium (27.2 mg/mL vs. 9.0 mg/mL for 10% solutions). Whilst the hepatic metabolism requirement for CaGN has been widely refuted, limited paediatric data suggest CaCl₂ may yield a greater response in mean arterial pressure (MAP) in critically ill children. Crucially, the safety profile favours CaGN; a substantial body of evidence indicates that the risk and severity of tissue necrosis following extravasation are markedly higher with CaCl₂.
CONCLUSION: The selection of a calcium preparation must be conditional and context-dependent. We recommend reserving CaCl₂ for central venous administration in volume-restricted or extreme emergent settings, whilst CaGN is the preferred choice for peripheral line administration or routine maintenance due to its superior safety profile.