Calcium%2525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an intravenous (IV) or oral calcium salt used to restore serum calcium levels or stabilize cardiac membranes in hyperkalemia. It provides 93 mg of elemental calcium per 1 gram of calcium gluconate (approx. 4.65 mEq). ## Primary Indications * Hypocalcemia (acute, symptomatic). * Hyperkalemia associated with cardiac toxicity (membrane stabilization). * Magnesium sulfate toxicity. * Calcium channel blocker overdose (adjunctive therapy). ## Adult Dosing * **Hypocalcemia:** 1–2 g IV infusion over 10–20 minutes. May repeat every 4–6 hours as needed based on serum calcium levels. * **Hyperkalemia (Cardioprotection):** 1–2 g IV push over 5–10 minutes. May repeat every 5–10 minutes if ECG changes persist. * **Administration:** IV rapid infusion must be performed cautiously; excessive rates can cause bradycardia and arrhythmias. ## Pediatric Dosing * **Hypocalcemia (Symptomatic):** 100–200 mg/kg/dose IV over 10–20 minutes (maximum 2 g/dose). May repeat as needed. * **Hyperkalemia:** 50–100 mg/kg/dose IV over 5–10 minutes (maximum 2 g/dose). * **Note:** Always verify individual institutional protocols for neonatal vs. pediatric weight-based dosing. ## Dose Adjustments * **Renal Impairment:** Use with caution; monitor serum calcium/phosphate levels closely. No strict dose reduction, but higher risk of hypercalcemia. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (relative contraindication; concurrent use can precipitate severe arrhythmias). ## Adverse Effects * **Common:** Hypotension, bradycardia, arrhythmias (with rapid infusion), metallic taste, flushing, local irritation. * **Severe:** Tissue necrosis following extravasation (calcium is a vesicant). ## Key Drug Interactions * **Digoxin:** Risk of severe cardiac arrhythmias; if necessary, infuse calcium very slowly. * **Ceftriaxone:** Physical incompatibility (causes precipitation); do not administer via the same Y-site or in the same line (48-hour separation required in neonates). * **Phosphate-containing solutions:** Risk of calcium-phosphate precipitation. ## Monitoring * **Cardiac:** Continuous ECG monitoring during IV administration. * **Laboratory:** Serum ionized calcium levels (preferred indicator of active calcium) or total calcium corrected for albumin; serum potassium. * **Site:** Inspect for evidence of extravasation (pain, swelling, erythema). ## Clinical Pearls * **Extravasation Management:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor; local hyaluronidase injections may be considered per facility protocol. * **Route:** IV preferred for acute stabilization. IM administration is contraindicated due to tissue necrosis risk. * **Calcium Gluconate vs. Chloride:** Gluconate is preferred in peripheral lines because it is less irritating; Calcium Chloride (3x more elemental calcium) must be given via central line when possible to avoid severe tissue necrosis. *** *Disclaimer: This information is for educational purposes only. Clinical practice varies by institution. Always verify dosages, contraindications, and compatibility with local hospital protocols, standard drug references (e.g., Lexicomp, Micromedex), and current prescribing information before administration.*