What is the recommended dose and timing for calcium administration in this protocol?

• A. Administer two grams IV daily
• B. Administer one gram IV/IO daily; Use after blood product transfusions
• C. Administer one gram IV daily; Use before transfusions
• D. Administer one gram IM daily

Answer: (B)

Calcium replacement is used during transfusion to counter the effects of citrate, which is used to preserve stored blood. Citrate binds calcium in the blood, lowering ionized calcium and risking impaired coagulation and cardiac function as transfusions continue. The protocol recommends giving one gram of calcium via IV or IO after blood product transfusions to promptly restore calcium levels when transfusion-related hypocalcemia is a concern. This route provides rapid correction, which you can’t rely on with intramuscular administration, and it’s timed to address the transfusion itself rather than as a routine daily dose or as a preventive measure before transfusion.