Category: Professional Posters
Purpose: Intravenous calcium is a commonly used electrolyte and both products (calcium gluconate and calcium chloride) have been recently on shortage. The goal of this project was to evaluate intravenous calcium replacement strategies in hospitalized patients in order to understand current practice including common trends and potential problems.
Methods: This retrospective chart review of patients receiving intravenous calcium was approved by the Institutional Review Board. Inclusion criteria included adults (age ≥ 19 years) who had an active order for intravenous calcium chloride or intravenous calcium gluconate. Patients were excluded if they were under the age of 19 or on dialysis. The primary endpoint was to identify the indication for intravenous calcium replacement and the secondary endpoint was to evaluate if the total calcium or ionized calcium lab value (if applicable) was the trigger for supplementation. Descriptive statistics was utilized to describe the study cohort and to summarize all outcomes of interest.
Results: 1736 patient charts between July 1, 2017 to June 30, 2018 had an active order for IV calcium. 100 of these patient charts were included in this study. The main reasons patients were excluded was due to either active dialysis or no clear indication for use. Of these 100 subjects, the average age was 59 years with 57% being of male gender. It is also important to note that 42% of these patients were also on concomitant vasopressors or potassium supplementation. Over half of these patients were being treated in an intensive care unit. 10% of patients required two or more doses with 1 patient receiving 7 total doses. 48% of the orders were for 2 grams of calcium gluconate and 42% were for 1 gram of calcium gluconate. 1 gram of calcium chloride was found to be ordered the least (10%). 47% of the time, the indication for intravenous calcium was clinically relevant hypocalcemia (total calcium less than 6.5 mg/dL or serum ionized calcium less than 1 mmol/L), followed by 27% for general hypocalcemia and 24% for hyperkalemia. Of the 70 patients with general hypocalcemia/clinically relevant hypocalcemia, 40% had ionized calcium drawn and was the trigger for supplementation.
Conclusion: Assessing the use of intravenous calcium in this medical institution proved that it has been used appropriately. Its use was mostly for critically ill patients with the proper indications and adequate lab values to support it. Using critical medications in times of shortage such as IV calcium should be routinely assessed to better appropriate its use. It is also vital that clinicians be made aware of drug shortages throughout the system. A quality review such as this one can serve to improve healthcare by identifying problems, implementing a corrective action plan, and monitoring for remediation if necessary.