Please check your internet connection and try again.
# Calcium gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used to restore serum calcium levels, manage hypocalcemic emergencies, and provide cardioprotection in hyperkalemia. It contains approximately 90 mg of elemental calcium per 1 gram of calcium gluconate (4.65 mEq).
## Primary Indications
* Acute symptomatic hypocalcemia.
* Hyperkalemia with EKG changes (cardioprotection).
* Magnesium 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 after 5 minutes if EKG changes persist.
* **Administration:** Max rate should generally not exceed 200 mg/minute to avoid bradycardia/arrhythmias.
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg/dose (max 2 g/dose) IV infusion over 10–20 minutes.
* **Hyperkalemia:** 50–100 mg/kg/dose (max 2 g/dose) IV over 5–10 minutes.
* *Note: Dosing should be verified by institutional protocol or weight-based guidelines.*
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment defined; monitor closely for hypercalcemia as renal clearance of calcium is reduced.
* **Hepatic Impairment:** No specific adjustments required.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation.
* Digitalis toxicity (relative contraindication; calcium can potentiate digitalis effects and worsen arrhythmias).
## Adverse Effects
* **Extravasation:** Severe tissue necrosis and sloughing; must ensure line patency.
* **Cardiovascular:** Bradycardia, syncope, hypotension, or arrhythmias if infused too rapidly (especially in patients on digoxin).
* **Local:** Burning sensation at the injection site.
* **GI:** Chalky taste, vomiting (if nausea occurs during infusion, slow the rate).
## Key Drug Interactions
* **Digoxin:** Calcium can increase myocardial irritability; use extreme caution.
* **Ceftriaxone:** Physical incompatibility (calcium-ceftriaxone precipitates). Do not co-administer in the same IV line; avoid in neonates (≤28 days) even in separate lines due to risk of fatal precipitates.
* **Phosphate/Bicarbonate:** Risk of precipitation; flush lines thoroughly between administrations.
## Monitoring
* **Serum Calcium:** Monitor ionized calcium or serum total calcium (corrected for albumin).
* **Cardiac:** Continuous EKG monitoring during IV administration, especially in emergency settings.
* **Local Site:** Monitor for infiltration/extravasation.
## Clinical Pearls
* **Calcium Gluconate vs. Chloride:** Calcium gluconate is preferred for peripheral administration because it is less tissue-irritating than calcium chloride. Calcium chloride contains 3x more elemental calcium per gram but must be given via central line when possible.
* **Correction:** Always correct total calcium for hypoalbuminemia: Corrected Ca = Serum Ca + 0.8 × (4.0 - Measured Albumin).
* **Stability:** If precipitation is observed in the IV bag, discard immediately.
***
**Educational Disclaimer:** This information is for educational purposes only. Always verify dosing, compatibility, and infusion rates with current institutional protocols, the package insert, or a reliable clinical database (e.g., Lexicomp or Micromedex) before prescribing or administering medication.
