Calcium repletion / membrane stabilization
Restores ionized calcium; raises the cardiac threshold against hyperkalemia
- Directly replaces calcium — no receptor pharmacology
- Restores cardiac membrane stability and neuromuscular function in hypocalcemia and hyperkalemia
- Ca²⁺ re-steepens the myocyte depolarization threshold hyperkalemia has flattened — works in minutes, moves no potassium
- Also the antidote scaffold for CCB overdose and hypocalcemic tetany
- ➔ calcium gluconate — peripheral-line safe; 3 g ≈ 1 g CaCl₂ elemental
- ➔ calcium chloride — 3× the elemental calcium; central line (extravasation necrosis)
- ⚠ Digoxin toxicity caution ("stone heart") is traditional teaching, weakly evidenced
Drugs with this mechanism (2)
- Calcium chloride — Concentrated IV calcium for severe hypocalcemia, hyperkalemia, and calcium-channel blocker toxicity.
- Calcium gluconate — Calcium replacement and cardiac membrane stabilizer; safer peripherally than calcium chloride.
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