P0175 / #1048: CALCIUM CHLORIDE VERSUS CALCIUM GLUCONATE DURING PAEDIATRIC RESUSCITATION. WHICH ONE IS BETTER? A SYSTEMATIC REVIEW OF THE EVIDENCE.

Abstract

Aims & Objectives: We undertook a systematic review regarding the usage of Calcium Gluconate (CaGN) and Calcium Chloride Cl2 (CaCl2) to ascertain if one confers a faster iCa rise during reuscitation. Secondary objectives included pharmacokinetics, therapeutic efficacy, adverse event profile and physiological implications to ascertain if there should be a clinical preference of one over the other during resucitation. Methods: Literature review using Cochrane library, Embase and Medline OVID interface. Results:It is purported that CaGN requires hepatic metabolism to release iCa, precluding its use in shock, cardiac arrest and hepatic impairment due to lower bioavailability and suboptimal biochemical effect. It is also suggested that CaCl2 has a faster ionisation time, thus could in theory provide iCa more quickly. Evidence is mixed and inconclusive. Additionally CaCl2 is likelier to cause tissue necrosis with extravasation injury; thereby rendering CaGN a safer option if used peripherally. Conclusions: Though few studies have proven that CaGN is equivalent to CaCl2 in ionisation, most were done in eucalcaemic, clinically stable subjects. The only randomised trial in critically ill children shows CaCl2 to be superior suggesting possibly altered calcium bioavailability in critical illness physiology due to changes in pH, albumin etc. Balancing risks and benefits of a potentially serious extravasation injury with CaCl2 versus its presumed benefit of faster rise in iCa is challenging. Based on the best available evidence, we feel it is prudent to use CaCl2 through a central access in order to treat hypocalcaemia in critically ill children, requiring resucitation, especially if the hypocalcemia is refractory.