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# Calcium gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used to restore serum calcium levels and manage cardioprotection in hyperkalemia. It provides approximately 93 mg (4.65 mEq) of elemental calcium per 1 gram of calcium gluconate. It is preferred over calcium chloride for peripheral administration due to lower risk of tissue necrosis.
## Primary Indications
* Hypocalcemia (acute/symptomatic)
* Cardioprotective adjunct in hyperkalemia (stabilization of cardiac membrane)
* Magnesium sulfate toxicity
* Calcium channel blocker overdose
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV administered slowly over 10–20 minutes. May repeat every 4–6 hours as needed based on serum calcium levels.
* **Hyperkalemia (Cardiac Protection):** 1–2 g IV over 5–10 minutes. May repeat after 5 minutes if ECG changes persist.
* **Maximum rate:** 200 mg/min (to prevent arrhythmias/hypotension).
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg/dose (max 2 g/dose) IV slowly.
* **Hyperkalemia:** 50–100 mg/kg/dose (max 2 g/dose) IV.
* *Note:* Always verify specific neonatal/pediatric institution-specific concentrations and infusion protocols.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment, but use with caution; monitor serum calcium levels closely to avoid hypercalcemia.
* **Hepatic Impairment:** No adjustment required.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Digitalis toxicity (relative contraindication; calcium can potentiate digitalis-induced arrhythmias)
* Severe renal calculi (history of)
## Adverse Effects
* **Injection site:** Extravasation can cause severe tissue necrosis and sloughing (ensure patency before infusion).
* **Cardiovascular:** Rapid infusion may cause bradycardia, hypotension, or syncope.
* **Gastrointestinal:** Chalky taste, nausea, or vomiting.
* **Other:** Tingling or heat sensation during infusion (“calcium flush”).
## Key Drug Interactions
* **Digoxin:** Calcium increases the risk of digitalis toxicity; use extreme caution if concurrent cardiac glycosides are present.
* **Ceftriaxone:** Incompatible in neonates (≤28 days) due to risk of calcium-ceftriaxone precipitate in lungs and kidneys (do not co-administer or use in same line).
* **Phosphate-containing solutions:** Physically incompatible; causes precipitation.
## Monitoring
* **Serum Calcium:** Total and ionized (preferred).
* **ECG:** Monitor closely during IV administration for bradycardia or arrhythmias.
* **Local:** Monitor infusion site frequently for infiltration/extravasation.
* **Renal Function:** Assess during prolonged therapy.
## Clinical Pearls
* **Extravasation Management:** If extravasation occurs, stop the infusion immediately and disconnect. Consider subcutaneous sodium thiosulfate injections if severe.
* **Preferred Route:** IV is preferred; IM administration is **not** recommended due to the potential for local tissue necrosis and abscess formation.
* **Accuracy:** 1 g of calcium gluconate is not equivalent to 1 g of calcium chloride (calcium chloride contains ~270 mg elemental calcium, nearly 3x more). Do not use interchangeably.
* **Documentation:** Always verify local institutional protocols for concentrations and maximum infusion rates, particularly in neonatal/ICU settings.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via reliable clinical databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*
