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# Calcium Gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used primarily for the treatment of hypocalcemia and as an antidote for cardiac toxicity associated with hyperkalemia or calcium channel blocker/magnesium toxicity. It provides less elemental calcium than calcium chloride (1g calcium gluconate ≈ 90mg elemental calcium vs. 1g calcium chloride ≈ 270mg).
## Primary Indications
* Acute symptomatic hypocalcemia.
* Hyperkalemic cardiac membrane stabilization (emergent).
* Magnesium toxicity (antidote).
* Calcium channel blocker overdose.
* Cardiac arrest (only if hyperkalemia, hypocalcemia, or hypermagnesemia is suspected).
## Adult Dosing
* **Hypocalcemia:** 1–2g IV infusion over 10–20 minutes. May repeat every 6 hours or follow with a continuous infusion adjusted based on serum calcium levels.
* **Hyperkalemia (Cardioprotection):** 1–2g IV push over 5–10 minutes. May repeat every 5–10 minutes if ECG changes persist.
* **Magnesium Toxicity/CCB Overdose:** 1–3g IV over 5–10 minutes; may require continuous infusion if symptoms persist.
## Pediatric Dosing
* **Hypocalcemia:** 100–200mg/kg/dose (maximum 2g) IV; infuse over 10–20 minutes.
* **Hyperkalemia (Cardioprotection):** 50–100mg/kg/dose IV; infuse over 5-10 minutes.
* *Note: Always verify pediatric dosing via weight-based institutional formularies (e.g., Lexicomp/Pediatric Dosage Handbook).*
## Dose Adjustments
* **Renal Impairment:** No specific adjustment, but use with extreme caution; monitor for hypercalcemia.
* **Hepatic Impairment:** No dosage adjustment necessary.
* **General:** Reduce rate of infusion if bradycardia or arrhythmias occur.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation (during resuscitation).
* Digitalis toxicity (increased risk of severe arrhythmias).
## Adverse Effects
* **Injection site:** Tissue necrosis/sloughing if extravasation occurs (calcium gluconate is less vesicant than calcium chloride but still high-risk).
* **Cardiac:** Bradycardia, arrhythmias, hypotension (with rapid infusion).
* **Systemic:** Flushing, syncope, metallic/chalky taste.
## Key Drug Interactions
* **Ceftriaxone:** Physical incompatibility; never mix in the same IV line or syringe. Precipitation risk in neonates (fatal).
* **Digoxin:** Calcium sensitizes the heart to effects of digoxin; may precipitate or worsen arrhythmia.
* **Tetracyclines/Fluoroquinolones:** Calcium decreases absorption (applicable to oral, but caution with concomitant clinical use).
## Monitoring
* **Cardiac:** Continuous ECG monitoring during rapid IV administration. Discontinue if bradycardia develops.
* **Laboratory:** Serum total/ionized calcium, magnesium, and phosphorus levels.
* **Site:** Assess for signs of extravasation frequently.
## Clinical Pearls
* **Extravasation Management:** Stop infusion immediately. If significant extravasation occurs, consult surgery/dermatology; some centers utilize sodium thiosulfate injections locally.
* **Administration:** Large-bore peripheral vein preferred. Central line required for concentrated or continuous infusions.
* **Compatibility:** Highly incompatible with many drugs (especially phosphates and carbonates). Flush lines thoroughly before and after administration.
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*Educational Disclaimer: This information is for educational purposes and does not substitute for professional medical judgment. Always verify dosages, contraindications, and drug compatibility via your institution’s current drug formulary and pharmacy department.*
