Toxin:: [[Hydrofluoric Acid]] # Formulations - Calcium gluconate 1 g/10 mL vials (0.22 mmol calcium ions/mL) # Dose ## paediatric dose 1 mL/kg 10% calcium gluconate solution over 5-10 min repeat Q 10-15 min # Indications - [[Calcium channel blocker overdose]] - [[Hypocalcemia]] - [[Hydrofluoric Acid|Hydrofluoric Acid local or systemic toxicity]] - [[hyperkalemia]] - hyper-mg # hypocalcaemia/hyperkalemia/hyper-mg - 5-10mL of calcium chloride 0.68mmol/mL or 10-20 mL of calcium gluconate 0.22mmol/L over 5-10 min - repeat Q 10-15 min as required ## Calcium channel blocker poisoning - 60 mL of 0.22mmol/L calcium gluconate IV over 5-10 min. - can repeat Q20 min for 3 doses # Hydrofluroic acid injury ## Topical 2.5% calcium genl for burns on hand, put gel in glove and place hand in glove > ==can be made== by mixing 10mL of 10% calcium gluconate solution wiht 30mL of lubricant gel eg K-Y jelly) or by mixing 3.5 g calcium gluconate powder in 150mL of lubricant gel) ## IV as above ## local injection - 0.5mL/cm^2 s/c with 25g needle (don't use calcium chloride or in fingers) ## Bier's block - [consider](x-devonthink-item://C8AE745C-C96E-4AEF-9010-D441840C6DF4?page=412&start=2&length=12&search=Bier%E2%80%99s%20block) for large HF exposures to fingers, hand, or forearm - 1g (10mL) calcium gluconate in 40mL normal saline - inject as per bier's block, release cuff after 20 min ## intra-artierial infusion - insert arterial line into radial, bracheal, or fem artery of affected limb - dilute 1g calcium glconate in 40mL normal saline - infusion diluted calcium glconate over 4 hours, repeat as necessary # Adverse reactions ## Transient hypercalcaemia - manifest by **tetany** and **seizures** - stop giving calcium and check serum level ## vasodilation, hypotension, syncope, cardiac arrest, arrhythmias - stop giving - ALS # Tips > - QT duration and clinical features of [[Hypocalcemia|hypo-Ca]] may be more useful to guide calcium requirements than serum calcium concentrations > - calcium gluconate can be given peripherally; calcium chloride best given central line because of risks of tissue damage from extravasation; it should not be given in same line as sodium bicarb > - do not use calcium salt solution to irrigate the eye after ocular hydrofluoric acid injury; can cauwse corrosive injury