Calcium%252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is a parenteral calcium salt used to manage acute hypocalcemia and calcium-channel blocker toxicity. It is preferred over calcium chloride for peripheral administration as it is less likely to cause tissue necrosis if extravasation occurs; however, it still requires caution. ## Primary Indications * Acute symptomatic hypocalcemia. * Hyperkalemia with EKG changes (cardioprotection). * Calcium channel blocker (CCB) toxicity. * Magnesium sulfate toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 grams (10–20 mL of 10% solution) IV administered over 10–20 minutes. May repeat every 6 hours or initiate a continuous infusion. * **Hyperkalemia/CCB Toxicity:** 1–3 grams (10–30 mL of 10% solution) IV push over 5–10 minutes. May repeat after 5 minutes if EKG changes persist. * **Continuous Infusion:** Typically 1–2 mg/kg/hour (elemental calcium) for maintenance. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV administered slowly over 10–20 minutes. * **Hyperkalemia/Emergency:** 100 mg/kg/dose (1 mL/kg of 10% solution) IV push, not to exceed adult maximum of 3 grams per dose. * *Note: Always verify doses in pediatric protocols, as concentration and infusion rates are critical.* ## Dose Adjustments * **Renal Impairment:** No specific adjustment, but monitor ionized calcium levels strictly. * **Hepatic Impairment:** No adjustment required. ## Contraindications * Hypercalcemia. * Ventricular fibrillation (during resuscitation). * Digitalis toxicity (calcium can potentiate digitalis-induced arrhythmias). ## Adverse Effects * **Common:** Hypotension, bradycardia, arrhythmias (if infused too rapidly). * **Local:** Injection site reaction, burning, phlebitis, or necrosis (if extravasated). * **Systemic:** Hypercalcemia symptoms (nausea, vomiting, confusion, polydipsia). ## Key Drug Interactions * **Digoxin:** Increased risk of life-threatening arrhythmias (avoid use unless mandatory). * **Ceftriaxone:** Physical incompatibility; the combination can form fatal precipitates in neonates. Do not co-administer or use in the same line. * **Phosphate-containing solutions:** Physically incompatible; precipitation occurs (calcium phosphate). ## Monitoring * **EKG:** Continuous monitoring during rapid IV administration. * **Laboratory:** Serum ionized calcium levels are preferred over total calcium. * **Site:** Check for patency prior to administration and monitor throughout to prevent extravasation. ## Clinical Pearls * **Elemental Calcium:** 1g of calcium gluconate contains approximately 90 mg (4.65 mEq) of elemental calcium, compared to 270 mg in 1g of calcium chloride. * **Administration:** If local extravasation occurs, stop the infusion immediately and disconnect. Consider phentolamine or sodium thiosulfate injections locally if severe. * **Protocol:** Always confirm infusion rates with local institutional policies, as rapid administration can cause cardiac arrest. If the patient is on digoxin, calcium should be avoided or administered with extreme caution. *** **Educational Disclaimer:** This information is for educational purposes only. Always verify drug doses, compatibility, and contraindications against current institutional protocols, prescribing literature, and electronic health record databases before administration.