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# Calcium gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used primarily for the treatment of hypocalcemia and as a cardioprotective agent in hyperkalemia. It provides 93 mg (4.65 mEq) of elemental calcium per 1 gram of calcium gluconate. It is generally preferred over calcium chloride for peripheral administration due to a lower risk of tissue necrosis.
## Primary Indications
* Acute symptomatic hypocalcemia.
* Adjunctive therapy in hyperkalemia (to stabilize the cardiac membrane; does not lower serum potassium).
* Calcium channel blocker or magnesium toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 grams (equivalent to 10–20 mL of 10% solution) IV slowly. May repeat every 1–3 hours as needed based on serum calcium levels.
* **Hyperkalemia / Cardiac Protection:** 1–2 grams IV administered over 5–10 minutes. May repeat after 5 minutes if ECG changes persist.
* **Maximum rate:** 200 mg/min (to prevent bradycardia and arrhythmias).
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg/dose IV slowly.
* **Cardiac stabilization (hypocalcemia/hyperkalemia):** 50–100 mg/kg/dose (max 2 grams).
* **Note:** Always verify individual institutional protocols, as concentrations and infusion rates vary significantly for neonates.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment necessary, but monitor levels closely to avoid hypercalcemia.
* **Hepatic Impairment:** No adjustment necessary.
## Contraindications
* Ventricular fibrillation.
* Hypercalcemia.
* Digitalis toxicity (increased risk of severe arrhythmias).
* Concurrent administration with phosphate-containing solutions in the same line (risk of precipitation).
## Adverse Effects
* **Common:** Peripheral vasodilation (transient hypotension), tingling, chalky taste, heat sensation, localized vein irritation.
* **Serious:** Bradycardia, cardiac arrhythmias (if infused too rapidly), tissue necrosis (if extravasation occurs).
## Key Drug Interactions
* **Digoxin:** Increased risk of digitalis toxicity; may precipitate severe arrhythmias.
* **Ceftriaxone:** Potential for fatal calcium-ceftriaxone precipitate in pulmonary and renal tissues (avoid simultaneous use, especially in neonates).
* **Tetracyclines/Fluoroquinolones:** Decreased absorption if oral calcium is taken concomitantly (though less relevant to IV use).
## Monitoring
* **Cardiac:** Continuous ECG monitoring during IV bolus administration. Observe for bradycardia or sinus arrest.
* **Laboratory:** Serum ionized calcium (preferred) or total serum calcium, potassium, magnesium, and phosphorus.
* **Site:** Monitor frequently for signs of extravasation (pain, redness, swelling).
## Clinical Pearls
* **Compatibility:** Calcium is highly incompatible with many medications, specifically sodium bicarbonate and phosphate-containing fluids. Flush lines thoroughly before and after administration.
* **Calcium Gluconate vs. Chloride:** Calcium gluconate is less likely to cause tissue irritation/necrosis compared to calcium chloride and is the preferred agent for peripheral IV access.
* **Extravasation:** If extravasation occurs, stop the infusion immediately. Consider warm compresses and, in severe cases, local injection of hyaluronidase.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution. Always verify specific dosages, infusion rates, and compatibility using current institutional protocols and the official manufacturer's prescribing information before administration.
