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# Calcium Gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used primarily for the urgent management of symptomatic hypocalcemia and as a cardioprotective agent in hyperkalemia. It contains approximately 93 mg of elemental calcium per 1 gram of injection.
## Primary Indications
* Acute symptomatic hypocalcemia (tetany, muscle cramps, laryngeal stridor, seizures).
* Cardiac membrane stabilization in severe hyperkalemia (with ECG changes).
* Calcium channel blocker overdose or magnesium toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 grams (10–20 mL of 10% solution) IV administered over 10–20 minutes. May repeat every 4–6 hours based on serum calcium levels.
* **Hyperkalemia:** 1–2 grams (1–2 ampules) 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) in peripheral lines to prevent extravasation or bradycardia.
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg/dose (1–2 mL/kg of 10% solution) slow IV push over 10–20 minutes. Max single dose: 2 grams.
* **Hyperkalemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) slow IV push. Max single dose: 2 grams.
* **Note:** Dosing is highly dependent on institutional protocols; verify via pediatric weight-based guidelines (e.g., Harriet Lane).
## Dose Adjustments
* **Renal Impairment:** Use with caution in patients with chronic kidney disease due to risk of metastatic calcification. Adjust frequency based on serum calcium and phosphate products.
* **Hypercalcemia:** Contraindicated.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation (during resuscitation).
* Digitalis toxicity (calcium may precipitate life-threatening arrhythmias).
* Severe renal impairment (relative).
## Adverse Effects
* **Injection site:** Extravasation can cause severe tissue necrosis and sloughing.
* **Cardiovascular:** Bradycardia, syncope, hypotension, and arrhythmias (if administered too rapidly).
* **Gastrointestinal:** Chalky taste, nausea, vomiting (with rapid infusion).
## Key Drug Interactions
* **Digoxin:** Calcium synergistically increases myocardial sensitivity to digitalis, potentially triggering fatal arrhythmias.
* **Ceftriaxone:** Physical incompatibility; co-precipitation can occur in neonates (do not mix in the same line).
* **Phosphates/Carbonates:** Potential for calcium-phosphate precipitation (use separate IV lines or flush thoroughly).
## Monitoring
* **Cardiac:** Continuous ECG monitoring during administration (watch for bradycardia or arrhythmias).
* **Labs:** Serum ionized calcium (preferred over total calcium), serum potassium, and phosphate.
* **Site:** Check for patency and signs of extravasation (pain, swelling, blanching) prior to and during infusion.
## Clinical Pearls
* **Extravasation Management:** If extravasation occurs, stop infusion immediately, elevate the limb, and consider hyaluronidase injections.
* **IV Access:** Central access is preferred for continuous infusions; peripheral administration should be reserved for bolus doses in large veins to minimize tissue damage risk.
* **Administration:** Ensure the solution is clear; if crystals are present, warm the ampule gently in water and shake until dissolved before use.
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**Disclaimer:** This information is for educational purposes only. Clinical protocols vary by institution. Always verify dosages, contraindications, and drug-drug interactions through your facility’s clinical guidelines or official prescribing information (package insert) before administration.
