Hello!

Was wondering what lab value other facilities use for Calcium replacement protocols. Ours currently tells RN to replace on either ionized Ca or corrected serum calcium.

However, RNs don't normally calculate corrected serum calcium and it seems ionized calcium is not something that's part of our main chemistry instruments in lab so testing isn't available (except we do get it in our ABGs).

What do other facilities use? Does anyone use serum calcium (not corrected)? I'd worry that we'd be prone to over correction if we did that...

Thanks!

We currently have an Epi/Cal drip in our formulary (epinephrine 4mg + CaCl 1gm / 250mL D5W). Our maximum rate is 20mL/hr (~5.333mcg/min of epinephrine). Our plain epinephrine drips (various concentrations) have a max rate of 50 mcg/min.

#1: If you currently use EPI/CAL, what evidence/references do you use to support its continued use? -1990's article in Circulation showed that "calcium blunts epinephrine's beta-adrenergic actions in postoperative cardiac surgery patients." We would like to use this article as a foundation for having EPI/CAL removed from formulary.