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Y-site simulation compatibility study of 10% calcium salts with various injectable solutions during toxicological resuscitation
  1. Arianne Hamelin1,
  2. Félix Thompson-Desormeaux2,
  3. Audrée Elliott3,
  4. Mihaela Friciu1,
  5. Jean-Marc Forest4,
  6. Gregoire Leclair5
  1. 1Université de Montréal, Montreal, Québec, Canada
  2. 2CIUSSS du Centre-Ouest-de-l'Ile-de-Montreal, Montreal, Québec, Canada
  3. 3CIUSSS de la Capitale-Nationale, Quebec, Québec, Canada
  4. 4Pharmacie, CHU Sainte-Justine, Montreal, Québec, Canada
  5. 5Faculté de pharmacie, Groupe de Recherche Universitaire sur le Médicament, Université de Montréal, Montreal, Québec, Canada
  1. Correspondence to Jean-Marc Forest, Pharmacie, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; jean-marc.forest.hsj{at}


Purpose To determine the physical compatibility of 10% calcium chloride and 10% calcium gluconate in combination with injectable solutions, administered in the paediatric and adult intensive care unit setting during toxicological resuscitation involving calcium channel blockers and beta-blockers.

Methods Forty-eight combinations were prepared at room temperature, including the following products: calcium chloride, calcium gluconate, insulin, epinephrine, norepinephrine, highly concentrated dextrose solution, sodium chloride, Plasma-Lyte A and Ringer’s lactate. A visual evaluation at times 0, 1, 4, 24, 48 and 72 hours and a particle count test with the LS-20 particle counter at times 0, 4, 24 and 72 hours were performed. The admixtures were considered incompatible if there was a precipitate, a colour change, turbidity, viscosity or a gas formation. The stability of calcium salts was also tested in empty IV bags and syringes by the particle count test.

Results All drug mixtures were found to be compatible by visual evaluation and using the particle counter based on United States Pharmacopoeia chapter 788 (USP<788>) specifications. Calcium salts were compatible with insulin and vasopressors in the tested combinations. The stability of 10% calcium salts in empty IV bags and polypropylene syringes was demonstrated for up to 48 hours at room temperature.

Conclusion All the combinations tested were physically compatible for up to 72 hours at room temperature. Clinical use of calcium salt infusions, at an undiluted concentration, in combination with these injectable solutions in a toxicological resuscitation context is considered clinically acceptable.

  • Critical Care
  • Administration, Intravenous
  • Drug Administration Routes
  • Safety

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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