Calcium%25252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt used to manage hypocalcemia and hyperkalemia-induced cardiac membrane stabilization. It contains approximately 90 mg of elemental calcium per 1 gram of calcium gluconate (a 10% solution provides 93 mg elemental Ca per 10 mL). ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in severe hyperkalemia (ECG changes). * Calcium channel blocker overdose or magnesium toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 g (10–20 mL of 10% solution) IV administered over 10–20 minutes. May repeat every 6 hours or initiate continuous infusion depending on severity. * **Hyperkalemia:** 1–2 g (10–20 mL of 10% solution) IV push over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Maximum rate:** Do not exceed 200 mg/minute (2 mL/minute of 10% solution) to prevent cardiac arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (1–2 mL/kg of 10% solution) IV slow push; maximum 2 g/dose. * **Hyperkalemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV push over 5–10 minutes. * **Note:** Dosing varies significantly by local institutional protocols, especially in neonatal populations. Always verify via standardized pediatric dosing charts. ## Dose Adjustments * **Renal Impairment:** Use with caution; monitor serum calcium levels closely. * **Hepatic Impairment:** No specific adjustments required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (relative contraindication; caution required as hypercalcemia may precipitate digitalis toxicity). ## Adverse Effects * **Local:** Extravasation can cause severe tissue necrosis and sloughing; ensure proper venous access (central line preferred for infusions). * **Systemic:** Bradycardia, arrhythmias, syncope, hypotension (if infused too rapidly), and metallic taste. ## Key Drug Interactions * **Digoxin:** Increased risk of toxicity; monitor for signs of digitalis intoxication. * **Ceftriaxone:** Calcium-ceftriaxone precipitation can occur in neonates; contraindicated in neonates ≤28 days. * **Compatibility:** Incompatible with many drugs (e.g., sodium bicarbonate, phosphates, tetracyclines) due to precipitation. Flush lines thoroughly. ## Monitoring * **Clinical:** Continuous ECG monitoring during IV administration. * **Labs:** Serial serum ionized calcium (preferred) or total calcium levels. Monitor magnesium and phosphate levels as replacement often requires co-management of these electrolytes. ## Clinical Pearls * Calcium gluconate is preferred over calcium chloride for peripheral administration because it is less vesicant, though central access is still preferred for continuous infusions. * Calcium gluconate does not lower serum potassium; it only stabilizes the myocardium against arrhythmias. * If extravasation occurs, stop the infusion immediately, elevate the limb, and consider hyaluronidase infiltration per institutional protocol. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*