A prospective, randomized, double-blind comparison of calcium chloride and calcium gluconate therapies for hypocalcemia in critically ill children

Abstract

Disturbances of ionized calcium levels have been reported in sick neonates, l and we have found a high rate of occurrence of ionized hypocalcemia, 2 which was associated with a significantly increased mortality rate in critically ill nonneonatal pediatric patients. Calcium chloride and calcium gluconate are two of the standard salt preparations that are used to correct hypocalcemia; the former is usually preferred because it is in the ionized form and therefore provides more readily available ionized calcium for use. In this study, critically ill pediatric patients with ionized hypocalcemia received either calcium chloride or calcium gluconate in a randomized manner. The purposes of this study were (1) to determine whether calcium chloride and calcium gluconate provide equal bioavailability of ionized calcium and (2) to assess whether there were any differences in physiologic effects after administration of the two salts. METHODS Patient selection. All patients admitted to the Le Bonheur Children's Medical Center intensive care unit were eligible for participation in this study if they were found to have hypocalcemia. Patients were enrolled in the study after informed consent was obtained in compliance with the investigational review boards of the University of Tennessee and LBCMC. Exclusion criteria were (1) calcium administration before arrival in the ICU and (2) no documentation of