Calcium repletion in liver insuff

 Q: In the presence of liver insufficiency, which one is preferred? (select one)

A) Calcium chloride 

B) Calcium gluconate

Answer: A

Calcium chloride does not require normal hepatic function to release ionized calcium into the blood. In contrast, the metabolism of calcium gluconate gets inhibited in liver insufficiency resulting in  slower ionized calcium release in blood.  

Said that care should be taken as calcium chloride carries 3 times more elemental calcium than calcium gluconate and aggressive repletion may lead to hypercalcemia.

#electrolytes

#hepatology

References:

1. British Committee for Standards in Haematology, Stainsby D, MacLennan S, et al. Guidelines on the management of massive blood loss. Br J Haematol 2006; 135:634.

2. Martin TJ, Kang Y, Robertson KM, Virji MA, Marquez JM. Ionization and hemodynamic effects of calcium chloride and calcium gluconate in the absence of hepatic function. Anesthesiology. 1990 Jul;73(1):62-5. doi: 10.1097/00000542-199007000-00010. PMID: 2360741.

3. Chakraborty A, Can AS. Calcium Gluconate. [Updated 2021 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557463/