BNF for Children 2011-2012

472 9.5.1 Calcium and magnesium BNFC 2011–20129 Nutrition and bloodCALCIUM SALTSCautions see notes above; sarcoidosis; history ofnephrolithiasis; avoid calcium chloride in respiratoryacidosis or respiratory failure; interactions: Appendix1 (antacids, calcium salts)Contra-indications conditions associated with hypercalcaemiaand hypercalciuria (e.g. some forms ofmalignant disease); see also Calcium Gluconateinjection, belowRenal impairment use with caution; risk of hypercalcaemiaand renal calculiSide-effects gastro-intestinal disturbances, constipation;bradycardia, arrhythmias; with injection, peripheralvasodilatation, fall in blood pressure, injectionsitereactions, severe tissue damage with extravasationIndication and doseSee notes above; calcium deficiency. By mouthNeonate 0.25 mmol/kg 4 times a day, adjusted toresponseChild 1 month–4 years 0.25 mmol/kg 4 times aday, adjusted to responseChild 5–12 years 0.2 mmol/kg 4 times a day,adjusted to responseChild 12–18 years 10 mmol 4 times a day,adjusted to responseAcute hypocalcaemia, urgent correction;hyperkalaemia (prevention of arrhythmias). By slow intravenous injection over 5–10 minutesNeonate 0.11 mmol/kg (0.5 mL/kg of calciumgluconate 10%) as a single dose. [Some units use adose of 0.46 mmol/kg (2 mL/kg calcium gluconate10%) for hypocalcaemia in line with US practice]Child 1 month–18 years 0.11 mmol/kg (0.5 mL/kg calcium gluconate 10%), max 4.5 mmol (20 mLcalcium gluconate 10%)Calcium Lactate (Non-proprietary)Tablets, calcium lactate 300 mg (calcium 39 mg orCa 2þ 1 mmol), net price 84 = £2.92Adcal c (ProStrakan)Chewable tablets, fruit flavour, calcium carbonate1.5 g (calcium 600 mg or Ca 2þ 15 mmol), net price100-tab pack = £7.25. Label: 24Cacit c (Warner Chilcott)Tablets, effervescent, pink, calcium carbonate 1.25 g,providing calcium citrate when dispersed in water(calcium 500 mg or Ca 2þ 12.5 mmol), net price 76-tabpack = £11.81. Label: 13Calcichew c (Shire)Tablets (chewable), orange flavour, calcium carbonate1.25 g (calcium 500 mg or Ca 2þ 12.5 mmol), netprice 100-tab pack = £9.33. Label: 24Forte tablets (chewable), orange flavour, scored,calcium carbonate 2.5 g (calcium 1 g or Ca 2þ25 mmol), net price 60-tab pack = £13.16. Label: 24Excipients include aspartame (section 9.4.1)Calcium-500 (Martindale)Tablets, pink, f/c, calcium carbonate 1.25 g (calcium500 mg or Ca 2þ 12.5 mmol), net price 100-tab pack =£9.46. Label: 25Calcium-Sandoz c (Alliance)Syrup, orange flavour, calcium glubionate 1.09 g,calcium lactobionate 727 mg (calcium 108.3 mg orCa 2þ 2.7 mmol)/5 mL, net price 300 mL = £4.07Sandocal c (Novartis Consumer Health)Sandocal 400 tablets, effervescent, orange flavour,calcium lactate gluconate 930 mg, calcium carbonate700 mg, providing calcium 400 mg (Ca 2þ 10 mmol),net price 5 20-tab pack = £6.87. Label: 13Excipients include aspartame (section 9.4.1)Sandocal 1000 tablets, effervescent, orange flavour,calcium lactate gluconate 2.263 g, calcium carbonate1.75 g, providing 1 g calcium (Ca 2þ 25 mmol), net price3 10-tab pack = £6.17. Label: 13Excipients include aspartame (section 9.4.1)Acute hypocalcaemia, maintenance. By continuous intravenous infusionNeonate 0.5 mmol/kg daily over 24 hours,adjusted to response, use oral route as soon aspossible due to risk of extravasationChild 1 month–2 years 1 mmol/kg daily (usualmax 8.8 mmol) over 24 hours, use oral route assoon as possible due to risk of extravasationChild 2–18 years 8.8 mmol over 24 hours, useoral route as soon as possible due to risk ofextravasationOral preparationsCalcium Gluconate (Non-proprietary)Effervescent tablets, calcium gluconate 1 g (calcium89 mg or Ca 2þ 2.23 mmol), net price 28-tab pack =£14.83. Label: 13Note Each tablet usually contains 4.46 mmol Na +Parenteral preparationsCalcium Gluconate (Non-proprietary) AInjection, calcium gluconate 10% (calcium 8.4 mg orCa 2þ 226 micromol)/mL. Net price 10-mL amp = 60pAdministration For intravenous infusion dilute to at least45 micromol/mL with Glucose 5% or Sodium Chloride 0.9%.Maximum administration rate 45 micromol/kg/hour (or in neonatesmax. 22 micromol/kg/hour). May be given more concentratedvia a central venous catheter. May be used undiluted (10%calcium gluconate) in emergencies. Avoid extravasation; shouldnot be given by intramuscular injection. Incompatible with sodiumbicarbonate and phosphate solutions.Note The MHRA has advised that repeated or prolongedadministration of calcium gluconate injection packaged in10 mL glass containers is contra-indicated in children under18 years and in patients with renal impairment owing to therisk of aluminium accumulation; in these patients the use ofcalcium gluconate injection packaged in plastic containers isrecommendedCalcium Chloride (Non-proprietary) AInjection, calcium chloride dihydrate 10% (calcium27.3 mg or Ca 2þ 680 micromol/mL), net price 10-mLdisposable syringe = £5.10Brands include Minijet c Calcium Chloride 10%