Is calcium gluconate more effective than calcium chloride in the treatment of hyperkalaemia?
Date First Published:
June 28, 2011
Last Updated:
August 11, 2011
Report by:
Jennifer Wright, Medical Student (University of Manchester)
Three-Part Question:
In [adults (>16 years) presenting to the emergency department with hyperkalaemia] is [Intravenous calcium gluconate more effective than intravenous calcium chloride] at [preventing cardiac arrhythmias]?
Clinical Scenario:
A 65 year-old man is referred to the ED by his GP with a serum potassium concentration of 6.5mmol/L. Repeat tests confirm hyperkalaemia. You order an ECG which shows characteristic hyperkalaemic changes.
You wonder whether you should prescribe calcium chloride or calcium gluconate, as you're not sure which is more effective.
You wonder whether you should prescribe calcium chloride or calcium gluconate, as you're not sure which is more effective.
Search Strategy:
Cochrane Library for Systematic Reviews: May 2011
MEDLINE using OVID interface: 1948 to June week 2
EMBASE: 1980 to 2011 week 24
Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus: 1947 to June 25th 2011
MEDLINE using OVID interface: 1948 to June week 2
EMBASE: 1980 to 2011 week 24
Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus: 1947 to June 25th 2011
Search Details:
COCHRANE:hyperkalaemia, hyperkalemia, hyperkal*, hyperpotass*, potassium and hyperpotassaemia
MEDLINE and EMBASE: [exp Potassium/ OR exp Hyperkalemia/ OR hyperkalaemia.mp/ OR high potassium.mp/ OR hyperkal$.mp/ OR hyperpotass$.mp] AND [calcium chloride.mp./ OR exp Calcium Chloride/ OR CaCl2.mp.] AND [calcium gluconate.mp/ OR exp Calcium Gluconate/] Limit to (english language and humans yr="2003 -Current")
CINAHL: [Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium gluconate] AND [calcium chloride/ OR CaCl2] Limit to (english language and humans)
MEDLINE and EMBASE: [exp Potassium/ OR exp Hyperkalemia/ OR hyperkalaemia.mp/ OR high potassium.mp/ OR hyperkal$.mp/ OR hyperpotass$.mp] AND [calcium chloride.mp./ OR exp Calcium Chloride/ OR CaCl2.mp.] AND [calcium gluconate.mp/ OR exp Calcium Gluconate/] Limit to (english language and humans yr="2003 -Current")
CINAHL: [Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium gluconate] AND [calcium chloride/ OR CaCl2] Limit to (english language and humans)
Outcome:
COCHRANE:51 papers found, 1 of which was relevant - search strategy dated to 2003.
MEDLINE: 0 papers found
EMBASE:37 papers found, none of which were relevant.
CINAHL:1 paper found, and not relevant to the clinical question.
MEDLINE: 0 papers found
EMBASE:37 papers found, none of which were relevant.
CINAHL:1 paper found, and not relevant to the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Emergency interventions for hyperkalaemia Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C 2005 Canada | RCTs, quasi-RCTs and randomised cross-over studies were included. |
Systematic review. 1a | Serum potassium, ECG changes, arrhythmia, adverse effects of therapy and death. | No relevant studies identified. |
Author Commentary:
There is no clinical evidence to support the use of either intravenous calcium gluconate or intravenous calcium chloride in the emergency management of hyperkalaemia.
Bottom Line:
As there is no clinical evidence available, local guidelines and advice should be followed.
References:
- Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C. Emergency interventions for hyperkalaemia