Calcium%2525252525252525252520gluconate

# Calcium gluconate ## Overview Calcium gluconate is an intravenous (IV) or oral calcium supplement used to treat acute hypocalcemia and cardiac toxicity related to hyperkalemia or hypermagnesemia. It is less irritating to peripheral veins than calcium chloride. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac stabilization due to hyperkalemia (does not lower potassium, but antagonizes membrane effects). * Magnesium toxicity. * Adjunct in calcium channel blocker or fluoride overdose. ## Adult Dosing * **Hypocalcemia:** 1–2 g (10–20 mL of 10% solution) IV slow bolus; may follow with a continuous infusion of 0.5–2 mg/kg/hr. * **Hyperkalemia/Cardiac Stabilization:** 1–2 g (10–20 mL of 10% solution) IV bolus over 5–10 minutes. May repeat after 5 minutes if ECG abnormalities persist. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg (0.5–1 mL/kg of 10% solution) per dose IV. Administer slowly over 5–10 minutes. * **Cardiac Stabilization (Hyperkalemia):** 50–100 mg/kg (max 2 g) IV over 5–10 minutes. *Note: Dosing can vary by institution or clinical guideline (e.g., PALS). Always verify against local pediatric formulary or weight-based protocols.* ## Dose Adjustments * **Renal Impairment:** No standard adjustment required, but monitor ionized calcium levels closely to prevent hypercalcemia. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Ventricular fibrillation (unless treating hyperkalemia). * Hypercalcemia. * Digitalis toxicity (calcium may precipitate arrhythmias). * Concurrent ceftriaxone therapy in neonates (due to risk of ceftriaxone-calcium precipitation). ## Adverse Effects * **Extravasation:** Severe tissue necrosis and sloughing (ensure patency of IV line). * **Rapid Administration:** Bradycardia, syncope, hypotension, and cardiac arrhythmias (if given too fast). * **Common:** Flushing, metallic taste, nausea/vomiting. ## Key Drug Interactions * **Digoxin:** Calcium synergizes with digitalis; risk of fatal arrhythmias. Avoid or use with extreme caution. * **Ceftriaxone:** Fatal chemical precipitation; never administer simultaneously in the same IV line (flush lines thoroughly). * **Tetracyclines/Fluoroquinolones:** Calcium reduces the absorption/efficacy of these oral antibiotics; space by at least 2 hours. ## Monitoring * **Cardiac:** Continuous ECG monitoring during IV administration for acute indications. Watch for bradycardia or QT shortening. * **Laboratory:** Pre- and post-dose ionized calcium or total serum calcium. Check serum potassium when treating hyperkalemia. * **Site:** Carefully assess IV site for infiltration. ## Clinical Pearls * **Calcium gluconate vs. chloride:** 1 g of calcium gluconate contains ~90 mg of elemental calcium, whereas 1 g of calcium chloride contains ~270 mg. They are not bioequivalent by weight. Calcium gluconate is preferred for peripheral administration. * **Extravasation:** If infiltration occurs, stop the infusion immediately and consider local infiltration with hyaluronidase per institutional protocol. * **Precipitation:** Do not mix with sodium bicarbonate, phosphate, or carbonate infusions. Use a dedicated line or flush thoroughly between medications. *** **Disclaimer:** This information is for educational purposes only. Clinical protocols and safety data change frequently. Always consult your current institutional guidelines and the most recent FDA-approved prescribing information before administering medications.