Calcium%252525252520gluconate

# Calcium gluconate ## Overview Calcium gluconate is an intravenous (IV) calcium salt used to manage acute hypocalcemia or calcium channel blocker/beta-blocker toxicity. It provides less elemental calcium (90 mg/g) compared to calcium chloride but is preferred for peripheral administration due to a lower risk of tissue necrosis. ## Primary Indications * Symptomatic hypocalcemia. * Hyperkalemia with EKG changes (cardioprotection). * Calcium channel blocker (CCB) toxicity. * Hypermagnesemia (symptomatic). * Hydrofluoric acid exposure (topical gel or local infiltration). ## Adult Dosing * **Hypocalcemia:** 1–2 g IV slow infusion over 10–20 minutes. May repeat every 4–6 hours as needed based on ionized calcium levels. * **Cardiac Protection/Toxicity:** 1–3 g IV push or slow infusion. May repeat as necessary based on EKG changes. * **Max Rate:** Do not exceed 200 mg/min (elemental calcium) to avoid bradycardia/arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (or 0.5–1 mL/kg of 10% solution) slowly IV. Repeat as needed based on clinical status and serum levels. * **Cardiac Protection:** 50–100 mg/kg IV slow push. * *Note: Always verify pediatric dosing against weight-based institutional protocols (e.g., Lexicomp/NeoFax) as neonatal and pediatric dosing can vary significantly based on indication.* ## Dose Adjustments * **Renal Impairment:** No standard adjustment required, but use with caution in chronic kidney disease; monitor serum calcium levels frequently. * **Hepatic Impairment:** No formal adjustments required. ## Contraindications * Hypercalcemia. * Ventricular fibrillation. * Digitalis toxicity (relative contraindication: calcium can precipitate severe arrhythmias if digitalis is present). ## Adverse Effects * **Common:** Peripheral vasodilation, hypotension, bradycardia (if pushed too rapidly). * **Serious:** Tissue necrosis/sloughing if extravasation occurs, cardiac arrhythmias, nephrocalcinosis (chronic use). * **Infusion site:** Phlebitis and pain. ## Key Drug Interactions * **Digoxin:** Calcium increases the risk of digoxin-induced arrhythmias. Use extreme caution. * **Ceftriaxone:** Do not administer concurrently or through the same IV line due to the risk of fatal calcium-ceftriaxone precipitate formation. * **Tetracyclines/Fluoroquinolones:** Calcium may decrease the absorption or efficacy if administered orally; IV spacing is less critical but consult clinical guidelines for specific timing. ## Monitoring * **Serum levels:** Ionized calcium (preferred) or total serum calcium. * **Cardiac:** Continuous EKG monitoring recommended for rapid infusions or high-dose therapy. * **Infusion site:** Vigilant monitoring for extravasation. * **Renal:** Consider baseline/periodical measurement of electrolytes and renal function. ## Clinical Pearls * **Extravasation:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor for tissue damage. Local administration of sodium thiosulfate may be considered per institutional protocol. * **Peripheral vs. Central:** Calcium gluconate is safer for peripheral lines than calcium chloride, but central administration is preferred for high-dose or frequent infusions. * **Not Interchangeable:** Calcium gluconate (90 mg elemental Ca/g) and calcium chloride (270 mg elemental Ca/g) are **not** milligram-equivalent. Dosing must be tailored to the specific salt used. *** **Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution. Always verify specific dosing, safety data, and compatibility with your current clinical resources, hospital protocols, or the official FDA-approved package insert before prescribing or administering medication.