The amount of calcium in calcium chloride - Is there a need to clarify emergency treatment of hyperkalaemia algorithm?

European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines emphasize a rapid administration of calcium chloride (10 ml 10 % CaCl2) to protect the myocardium in the hyperkalaemia algorithm. However, calcium chloride preparations available in European markets vary from country to country. In our opinion, the drug dose recommended in the guidelines should not raise questions about the volume and amount of calcium in the intravenous supply and should be unambiguous to minimize the risk of error. Calcium dose should be given in terms of mmol/L or mEq or mg of calcium ions.

Sudden Cardiac Arrest in a Patient With COVID-19 as a Result of Severe Hyperkalemia After Administration of Succinylcholine Chloride for Reintubation. A Case Report.

Background: We present a case study of a man with coronavirus disease 2019 (COVID-19) who developed cardiac arrest as a result of hyperkalemia following administration of chlororsuccinylcholine during endotracheal intubation. Case Summary: A patient with a severe course of COVID-19, hospitalized in the Intensive Care Unit, underwent reintubation on day 16. The applied scheme was rapid sequence induction and intubation with administration of chlororsuccinylcholine. Immediately after intubation, there was a sudden cardiac arrest due to hyperkalemia (cK + 10.2 meq/L). Treatment was initiated as per guidelines, which resulted in a return to spontaneous circulation after 6 min. Conclusion: Chlorsucynylcholine may cause life-threatening hyperkalemia. We recommend using rocuronium as a neuromuscular blocking agent in critically ill COVID-19 patients due to its more optimal safety profile.