칼슘염 (글루콘산 칼슘, 염화 칼슘, 젖산 칼슘, 글루셉산 칼슘)

동물 종별 용량

투여 경로

금기

• Ventricular fibrillation
• Hypercalcemia

이상반응

• Hypercalcemia
• GI irritation and/or constipation (oral administration)
• Mild to severe tissue reactions, pyogranulomatous panniculitis, adipocyte mineralization (IM or SC administration)
• Venous irritation (IV administration)
• Hypotension (if given IV too rapidly)
• Cardiac arrhythmias and cardiac arrest (if given IV too rapidly)

약물 상호작용

• Calcium Channel Blockers (e.g., diltiazem, verapamil) · Intravenous calcium may antagonize the effects of calcium-channel blocking agents.
• Digoxin · Patients on digitalis therapy are more apt to develop arrhythmias if receiving IV calcium; use with extreme caution.
• Magnesium (oral) · May lead to increased serum magnesium and/or calcium, particularly in patients with renal failure.
• Magnesium Sulfate (parenteral) · Parenteral calcium can neutralize the effects of hypermagnesemia or magnesium toxicity secondary to parenteral magnesium sulfate.
• Neuromuscular Blockers (e.g., atracurium, vecuronium, tubocurarine) · Parenteral calcium may reverse the effects of nondepolarizing neuromuscular blocking agents; has been reported to prolong or enhance the effects of tubocurarine.
• Tetracyclines, Fluoroquinolones (oral) · Oral calcium can reduce the amount of these antibiotics absorbed from the GI tract via chelation; separate dosages by at least two hours.
• Potassium Supplements · Patients receiving both parenteral calcium and potassium supplementation may have an increased chance of developing cardiac arrhythmias.
• Thiazide Diuretics · Used in conjunction with large doses of calcium may cause hypercalcemia.
• Vitamin A · Excessive intake may stimulate calcium loss from bone and cause hypercalcemia.
• Vitamin D · Concurrent use of large doses of vitamin D or its analogs may cause enhanced calcium absorption and induce hypercalcemia.

모니터링

• Serum calcium (total and ionized)
• Serum magnesium, phosphate, and potassium
• Serum PTH (parathormone) if indicated
• Renal function tests
• ECG and heart rate (continuously during IV therapy)
• Urine calcium (if hypercalciuria develops)

과용량

Oral overdoses of calcium-containing products are unlikely to cause hypercalcemia unless other drugs (e.g., Vitamin D) are given concurrently that enhance absorption. **Hypercalcemia** can occur with parenteral therapy or oral therapy combined with Vitamin D or increased PTH levels. * **Mild hypercalcemia:** Generally resolves without intervention when renal function is adequate. Withhold calcium therapy and Vitamin D analogs. * **Serious hypercalcemia (>12 mg/dL):** Treat by hydrating with IV normal saline and administering a loop diuretic (e.g., **furosemide**) to increase sodium and calcium excretion. Monitor and replace potassium and magnesium as necessary. Monitor ECG. Corticosteroids, calcitonin, and hemodialysis may also be employed.