Calcium%252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an intravenous calcium salt used to restore serum calcium levels or mitigate the cardiotoxicity of hyperkalemia. It provides 90 mg (4.65 mEq) of elemental calcium per 1 gram. It is preferred over calcium chloride for peripheral administration due to a lower risk of tissue necrosis. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in hyperkalemia (does not lower potassium). * Calcium channel blocker overdose or magnesium toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 g IV infusion over 10–20 minutes. May repeat every 6 hours or follow with a continuous infusion titrated to serum calcium. * **Hyperkalemia/Cardioprotection:** 1–2 g IV push over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Max Rate:** Do not exceed 200 mg/minute (2 mL/minute of 10% solution) to prevent bradycardia/arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose IV slowly over 10–20 minutes. Maintenance via continuous infusion may be required. * **Hyperkalemia/Emergency:** 50–100 mg/kg/dose (max 2 g) IV administered slowly over 5–10 minutes. * *Note: Always verify with local institutional pediatric nomograms.* ## Dose Adjustments * **Renal Impairment:** No specific adjustment, but monitor ionized calcium closely to prevent hypercalcemia/calcinosis. * **Hepatic Impairment:** No adjustments required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (increased risk of severe arrhythmias). * Do not mix with phosphate-containing solutions (risk of calcium phosphate precipitation). ## Adverse Effects * **Common:** Peripheral vasodilation (flushing), hypotension, bradycardia (if pushed too fast), dysgeusia (chalky taste). * **Serious:** Extravasation leading to tissue necrosis, severe hypercalcemia, cardiac arrest. ## Key Drug Interactions * **Digoxin:** Calcium synergistically increases digitalis toxicity. Use with extreme caution. * **Ceftriaxone:** Concurrent use in neonates causes fatal precipitation in lungs/kidneys; avoid in neonates ≤28 days. * **Tetracyclines/Fluoroquinolones:** Calcium can chelate these, reducing absorption (relevant if transition to oral). ## Monitoring * **ECG:** Mandatory during IV administration for cardiotoxicity. * **Labs:** Serum ionized calcium (preferred) or total calcium, magnesium, and potassium. * **Clinical:** Monitor IV injection site for phlebitis or extravasation. ## Clinical Pearls * **Peripheral vs. Central:** Calcium gluconate is less sclerosing than calcium chloride, but extravasation remains a risk. Avoid small peripheral veins if possible. * **Flush:** Always flush lines thoroughly between calcium and incompatible medications (especially bicarbonate or phosphate) to prevent precipitation. * **Serum Levels:** Remember that total calcium must be corrected for albumin: *Corrected Ca = Serum Ca + 0.8 × (4.0 - Albumin).* *** **Disclaimer:** This information is for educational purposes only. Clinical practice protocols and dosing guidelines vary by institution. Always verify dosages and compatibility using current institutional resources, the package insert, or professional clinical pharmacy services before prescribing or administering medication.