Calcium%25252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an intravenous calcium salt used to restore serum calcium levels, manage hypocalcemia, and stabilize cardiac membranes in hyperkalemia. It contains approximately 90 mg of elemental calcium per 1 gram of calcium gluconate. It is less tissue-irritating than calcium chloride. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac stabilization in hyperkalemia (cardioprotection). * Calcium channel blocker overdose. * Magnesium toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 g IV administered over 10–20 minutes. May repeat every 4–6 hours as needed based on serum calcium levels. * **Hyperkalemia (Cardioprotection):** 1–2 g IV over 5–10 minutes. May repeat if ECG changes persist. * **Calcium Channel Blocker Overdose:** Typically 1–3 g IV bolus, followed by a continuous infusion (e.g., 0.5–1.5 mg/kg/hour), titrated to clinical response. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose IV over 10–20 minutes. Max single dose: 2 g. * **Hyperkalemia:** 50–100 mg/kg/dose IV over 5–10 minutes. * *Note: Always verify dose with local pediatric/NICU guidelines as practice varies by institution.* ## Dose Adjustments * **Renal Impairment:** Use with caution; monitor serum calcium levels closely to avoid hypercalcemia. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (increased risk of severe arrhythmias). * *Note: Do not administer IM or SC (causes severe tissue necrosis).* ## Adverse Effects * **Rapid infusion:** Bradycardia, syncope, hypotension, dysrhythmias, flushing. * **Extravasation:** Severe chemical irritation, tissue necrosis, and sloughing. * **Gastrointestinal:** Nausea and vomiting (with oral administration). ## Key Drug Interactions * **Digoxin:** Calcium synergistically increases risk of digitalis toxicity/arrhythmias; avoid unless absolutely necessary. * **Ceftriaxone:** Physical incompatibility (precursor to fatal calcium-ceftriaxone precipitation in neonates). Separate administration by at least 48 hours or use different IV lines in adults. * **Phosphate-containing solutions:** Risk of calcium-phosphate precipitation. Use separate IV tubing or flush thoroughly. ## Monitoring * **Serum Calcium:** Monitor total and ionized calcium levels periodically. * **ECG:** Continuous cardiac monitoring required during IV bolus administration. * **Injection Site:** Assess for patency and signs of extravasation (pain, swelling, blanching). ## Clinical Pearls * **Preferred over Calcium Chloride:** Calcium gluconate is preferred for peripheral administration because it is less likely to cause tissue necrosis if extravasation occurs. If central access is available, calcium chloride (which provides 3x more elemental calcium per gram) may be preferred for severe acute emergencies. * **Precipitation:** Never mix with bicarbonate or phosphate buffers in the same syringe or IV line. * **Infusion rate:** Always use an infusion pump for bolus doses to ensure strict rate control and prevent cardiac irritability. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical guidelines and local protocols vary significantly. Always verify concentrations, dosages, and compatibility with your institution's pharmacy department and the most current prescribing information (e.g., package insert or clinical decision support systems) before administration.